Download How Faculty Can Recognize & Manage Mental Health Issues in the

How Faculty Can Recognize &
Manage Mental Health Issues in
the Classroom
Peggy Mitchell Norwood, Ph.D.
Psychologist, Consultant
[email protected]
Which one of these
students has a
mental health issue?
A female student who never speaks in class, pantomimes, and
has her boyfriend speak for her
B. A male student who accuses his female professor of constantly
staring at him and aggressively bumps up against her as he
leaves the classroom
C. A female student who bursts into tears and runs out of the
classroom when it is her turn to make her oral presentation to the
class
D. A 16 year old concurrent enrollment high school student who tips
his chair backwards, intentionally falls to the floor, and remains
there until the whole class notices
A.
Behavior Problem vs.
Mental Health Issue
• Some classroom behavior problems might
be related to mental health issues
• Some mental health issues never become
classroom behavior problems
• You might use different classroom
management strategies and recommend
different resources if you believe a student
has a mental health issue
“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
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
Why is
This Topic Important?
NIMH Statistics: Any disorder
among adults, retrieved from
http://www.nimh.nih.gov/statistics
/1ANYDIS_ADULT.shtml
NIMH Statistics: Any disorder
among adults, retrieved from
http://www.nimh.nih.gov/statistics
/1ANYDIS_ADULT.shtml
More Statistical Information
National Institute of Mental Health (2012) Statistics, retrieved
from http://www.nimh.nih.gov/statistics/index.shtml on
March 28, 2012.
Discharge Plan:
“Why don’t you
take a class or two
at the local community
college?”
Freedigitalphotos.net
“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
“MAD”
BAD
• Disruptive
• Schizophrenia & Other
• Inappropriate
• Attention-seeking
•
• Irritating
•
• Immature
•
• Rude
•
Psychotic Disorders
Bipolar Disorder
Major Depressive Disorder
Personality Disorders
Anxiety Disorders
Defining Abnormal Behavior - 4 Ds
• Distress
• Disability
• Deviant
• Dangerous
Are students allowed
to be
“just plain strange”?
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/collegecampuses.aspx on March 28, 2012.
Brief Overview of Disorders
Disorders
• Schizophrenia & Other Psychotic
Disorders
• Bipolar Disorder
• Major Depressive Disorder
• Personality Disorders
• Anxiety Disorders
DSM IV TR
Screenshot
http://www.amazon.com/gp/product/08
90420254/ref=pd_lpo_k2_dp_sr_1/183
28797662404540?pf_rd_m=ATVPDKI
KX0DER&pf_rd_s=lpo-top-stripe1&pf_rd_r=0JN3VEX4GCSKRVE8MA
J8&pf_rd_t=201&pf_rd_p=486539851
&pf_rd_i=0890420262
Online Criteria for Diagnosing
Mental Disorders
http://behavenet.com/apa-diagnostic-classification-dsm-iv-tr
Schizophrenia
• Severe disorder characterized by disturbance
in thought, behavior and emotions
• Marked impairment in social or occupational
(or school) functioning
Freedigitalphotos.net
“I was scared because I was having weird
thoughts, that cameras were watching me
in the school.”
-email from a student
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
Examples
Hallucinations:
http://www.youtube.com/watch?v=s33Y5nI5Wbc
Disorganized speech:
http://www.youtube.com/watch?v=avbfd_OkLoU&feat
ure=results_main&playnext=1&list=PLDE8B2510DB23
030E
Other Psychotic Disorders
Screenshot
http://www.nextmovie.com/
blog/youngest-oscarnominees-winners-of-alltime/
• Delusional Disorder -
Erotomanic Type
(eg.,John Hinckley)
• Brief Psychotic Disorder
(eg., “Snapped”)
Screenshot
http://en.wikipedia.org/wiki/John_Hinckl
ey,_Jr.
I worked in an Elite-Pioneering Research, Development and Design Environment. The Dogma 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
It’s a myth that
mentally ill people
are more violent…
(“But what about
James Holmes??”)
Screenshot http://www.imdb.com/title/tt0081505/
Bipolar Disorder
Disturbance in mood typically characterized by
periods of mania and depression
Freedigitalphotos.net
Symptoms of Mania
• Elevated, euphoric, or
•
•
•
•
•
•
•
irritable mood
Hyperactivity
Inflated self esteem or
grandiosity
Decreased need for sleep
Pressured speech
Flight of ideas
Distractibility
Self-destructive,
pleasurable activities
http://youtu.be/h5aSa4tmVNM?t=57s
“I’m not bipolar, I’m bi-winning!”
- Charlie Sheen
Appearance (“Manic Makeup”)
Screenshot https://illreviewanything.wordpress.com/2011/06/10/baby-wipes/
Symptoms of Depression
• Depressed, sad mood
• Loss of pleasure or interest
Freedigitalphotos.net
• Feelings of worthlessness
• Diminished ability to think or concentrate
• Indecisiveness
• Recurrent thoughts of death, suicide attempts
Example of Bipolar Disorder
http://www.youtube.com/watch?v=f-znjojBojc&feature=related
http://www.youtube.com/watch?v=ahfwEgpIAWg&feature=related
“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
Suicidal Ideation
• Never be afraid to inquire directly
• “Are you having thoughts of killing or
harming yourself?”
• Assess the seriousness of their
thoughts/plan using “SLAP”
 Specificity
 Lethality
 Availability
 Proximity (or Previous Attempts)
Have you ever encountered a suicidal student?
Where were they in regards to the “SLAP”
assessment?
Suicide Intervention
• Call 911 or Mobile Crisis Unit
• Share Suicide Hotline numbers:
• 1-800-SUICIDE
• 1-800-273-TALK
Personality Disorders
Rigid, pervasive, enduring, selfdefeating 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/20
11/11/what-is-personality-disorder.html
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
Histrionic Personality Disorder
• Excessively
emotional
• Dramatic attentionseeking
• Sexually provocative
behavior or
appearance
• “Drama King” or
“Drama Queen”
Freedigitalphotos.net
Borderline Personality Disorder
• Unstable moods,
relationships, and selfimage
• Intense anger
• All or nothing thinking
• Eg., Glenn Close in “Fatal
Attraction”
Screenshot
http://www.ew.com/ew/gallery/0,,20256
078_20572167,00.html#20572167
“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
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/U
S/bundy106.htm
Anxiety Disorders
Excessive, irrational dread,
worry, or nervousness that is out
of proportion to the situation or
persists longer than reasonable
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
Panic Attack
• Palpitations, sweating,
trembling, chest pain,
dizziness
• Fear of going crazy
• Feeling detached from
oneself
Screenshot
http://www.sheknows.com/parenting/arti
cles/810080/could-it-be-a-panic-attack
Post Traumatic Stress Disorder
(PTSD)
• Exposure to a traumatic event
involving actual or threatened
death or serious injury where
the person's response
involved intense fear,
helplessness, or horror
• Leads to anxiety, reexperiencing of the event,
numbing, and avoidance of
stimuli related to the event
Screenshot
http://www.thehealthculture.com/2010/07/suicid
e-among-veterans-is-an-%E2%80%9Cabsolutecrisis%E2%80%9D/ptsd-soldier-crying/
Symptoms of PTSD
• Intrusive disturbing memories
• Feelings of
• Nightmares
• Flashbacks
• Intense psychological distress
• Physiological reactivity
• Persistent avoidance of
thoughts, feelings,
conversations, activities, places,
people associated with the
trauma
• Diminished interest/participation
in activities
•
•
•
•
•
•
•
detachment/estrangement from
others
Restricted range of feelings
Sense of foreshortened future
Difficulty falling or staying
asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance
Exaggerated startle response
How does believing a student has a mental
disorder (vs. a behavior problem)
change your response?
Stay in Your Lane
Be clear in advance
how you plan to
handle these types of
situations
Freedigitalphotos.net
Managing
Disruptive Behaviors
• Make expectations about classroom behavior (for everyone)
clear on day one (eg. Syllabus)
• Acknowledge and deal with inappropriate, bizarre, disturbing,
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.
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”)
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
Making a Referral
• Acknowledge a change in behavior or inappropriate
•
•
•
•
behavior
State your concern directly and what you intend to do about
it - don’t be sworn to secrecy or collude with students
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
Contact the appropriate campus office/department yourself
to consult and make referral
Top 5 Helpful “Soundbites”
1. “I’m concerned about the outburst you had in class
2.
3.
4.
5.
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.”
Possible Resources
and Referral Sources
• 911
• Campus Security
• Campus Counseling Office (if available)
• Accessibility (Disability) Services
• Community Mental Health Center
• Suicide Hotline
• Community Crisis Intervention Line or Local Mobile Crisis
Unit
• Others?
“This is a personal message not really pertaining to
school. I realize this is not part of your job
description, but I appreciate the fact that you did
notice my mood Thursday in class…”
- email from a student
Resources
National Depression Screening Day Online Screening Tool
http://www.mentalhealthscreening.org/programs/colleges/ndsd
.aspx
Online Screening for Social Anxiety
http://www.adaa.org/living-with-anxiety/ask-andlearn/screenings/screening-social-anxiety-disorder
First person narratives of students with mental disorders
http://www.nami.org/Template.cfm?Section=NAMI_on_Campus
&template=/ContentManagement/ContentDisplay.cfm&Conten
tID=12236
Resources
Virtual hallucinations – simulation on Second Life of what it is
like to experience hallucinations and delusions:
http://www.youtube.com/watch?v=s33Y5nI5Wbc
Example of disorganized speech that is common in
Schizophrenia:
http://www.youtube.com/watch?v=avbfd_OkLoU&feature=resul
ts_main&playnext=1&list=PLDE8B2510DB23030E
Case example of someone with Bipolar Disorder:
http://www.youtube.com/watch?v=f-znjojBojc&feature=related
http://www.youtube.com/watch?v=ahfwEgpIAWg&feature=relat
ed
Questions or Comments?
Peggy Mitchell Norwood, Ph.D.
[email protected]
www.DrPegOnline.com
720-212-4028
Consulting | Workshops | Transformation