“Mad” or Bad? Helping Faculty To Recognize & Manage Student Mental Health Issues

Peggy Mitchell Norwood, Ph.D.

Professor of Psychology

Community College of Aurora

Peggy.Norwood@CCAurora.edu

Which scenario really happened?

A. A 22 year old female student never spoke in class, pantomimed, and had her boyfriend “interpret” for her.

B. A 25 year old male student accused his female professor of constantly staring at him and aggressively bumped up against her as he left the classroom.

C. A 17 year old female student burst into tears and ran out of the classroom when it was her turn to make her oral presentation to the class.

D. A 16 year old concurrent enrollment high school student tipped his chair backwards, intentionally fell to the floor, and remained there until the whole class noticed.

Behavior Problem vs. Mental Health Issue

• Some classroom behavior problems might be related to mental health issues

• 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

Any one behavior is not sufficient to diagnose a mental disorder

Continuum of Behavior

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:

Freedigitalphotos.net

“Why don’t you take a class or two

at the local community college?”

“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

BAD• Disruptive • Inappropriate• Attention-seeking• Irritating• Immature• Rude

“MAD”• Schizophrenia & Other

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/college-campuses.aspx on March 28, 2012.

Brief Overview of Disorders

DSM IV TR Behavenet.comhttp://behavenet.com/apa-diagnostic-classification-dsm-iv-tr

Screenshot http://www.amazon.com/gp/product/0890420254/ref=pd_lpo_k2_dp_sr_1/183-28797662404540?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=lpo-top-stripe-1&pf_rd_r=0JN3VEX4GCSKRVE8MAJ8&pf_rd_t=201&pf_rd_p=486539851&pf_rd_i=0890420262

Schizophrenia

• Severe disorder characterized by disturbance in thought, behavior and emotions

• Marked impairment in social or occupational (or school) functioning

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“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&feature=results_main&playnext=1&list=PLDE8B2510DB23030E

Other Psychotic Disorders

• Delusional Disorder - Erotomanic Type

(eg.,John Hinckley)• Brief Psychotic Disorder (eg., “Snapped”)

Screenshot http://www.nextmovie.com/blog/youngest-oscar-nominees-winners-of-all-time/

Screenshot http://en.wikipedia.org/wiki/John_Hinckley,_Jr.

It’s a myth that mentally ill people

are more violent

Screenshot http://www.imdb.com/title/tt0081505/

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

Bipolar Disorder

Disturbance in mood typically characterized by periods of mania and depression

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Symptoms of Mania• Elevated, euphoric, or irritable mood

• Inflated self esteem or grandiosity

• Decreased need for sleep

• Pressured speech• Flight of ideas• Distractibility• Self-destructive, pleasurable activities “I’m not bipolar, I’m bi-winning!”

- Charlie Sheen

http://youtu.be/h5aSa4tmVNM?t=57s

Appearance (“Manic Makeup”)

Screenshot https://illreviewanything.wordpress.com/2011/06/10/baby-wipes/

Symptoms of Depression

• Depressed, sad mood• Loss of pleasure or interest • Feelings of worthlessness• Diminished ability to think or concentrate• Indecisiveness• Recurrent thoughts of death, suicide attempts

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Example of Bipolar Disorder

http://www.youtube.com/watch?v=f-znjojBojc&feature=relatedhttp://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 the thoughts using “SLAP” • Specificity • Lethality• Availability• Proximity

Have you ever encountered a suicidal student? How did you handle the situation?

Suicide Intervention

• Call 911 or Mobile Crisis Unit• Share Suicide Hotline numbers• 1-800-SUICIDE• 1-800-273-TALK

Personality Disorders

Rigid, pervasive, enduring, self-defeating 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 attention-seeking

• Sexually provocative behavior or appearance

• “Drama King” or “Drama Queen”

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Borderline Personality Disorder

• Unstable moods, relationships, and self-image

• 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/US/bundy106.htm

Anxiety Disorders

Excessive, irrational dread, worry, or nervousness that is out of proportion to the situation or persists longer than reasonable

• 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

Social Phobia

Panic Attack

• Palpitations, sweating, trembling, chest pain, dizziness

• Fear of going crazy • Feeling detached from oneself Screenshot

http://www.sheknows.com/parenting/articles/810080/could-it-be-a-panic-attack

Have you ever encountered a student who showed signs of a mental disorder?

Schizophrenia | Bipolar Disorder | Depression | Suicide | Personality Disorders | Anxiety Disorders

How does believing a student has a mental disorder (vs. a behavior problem)

change your response?

How did you handle the situation?

Stay in Your Lane

Be clear in advance how you plan to handle these types of situations

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Managing Disruptive Behaviors

• Make expectations about classroom behavior (for everyone) clear on day one (eg. Syllabus)

• Acknowledge and deal with inappropriate, bizarre, 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:GlaringClenching fists or teeth Invading your (or other students’) personal space or “bumping” you

YellingPacing (“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!

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Making a Referral

• Acknowledge a change in behavior or inappropriate behavior

• State your concern directly and what you intend to do about it

• 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

Top 5 Helpful “Soundbites”1. “I’m concerned about the outburst you had in class

yesterday and want to refer you to speak to someone.”2. “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.”

3. “I don’t feel comfortable letting you leave here today without getting some help.”

4. “Would you be willing to call or walk over to the Counseling Office right now and make an appointment?”

5. “Your behavior is disruptive and scary to your classmates. I need to refer you to the Student Disciplinary Committee.”

Possible Resourcesand Referral Sources• 911• Campus Security• Campus Counseling Office (if available)• Accessibility (Disability) Services• Community Mental Health Center• Suicide Hotline• Community Crisis Intervention Line or 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

ResourcesNational Depression Screening Day Online Screening Toolhttp://www.mentalhealthscreening.org/programs/colleges/

ndsd.aspx

Online Screening for Social Anxietyhttp://www.adaa.org/living-with-anxiety/ask-and-learn/

screenings/screening-social-anxiety-disorder

First person narratives of students with mental disordershttp://www.nami.org/Template.cfm?

Section=NAMI_on_Campus&template=/ContentManagement/ContentDisplay.cfm&ContentID=12236

ResourcesVirtual 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=results_main&playnext=1&list=PLDE8B2510DB23030E

Case example of someone with Bipolar Disorder:http://www.youtube.com/watch?v=f-znjojBojc&feature=relatedhttp://www.youtube.com/watch?

v=ahfwEgpIAWg&feature=related

Questions or Comments?

Peggy Mitchell Norwood, Ph.D.Community College of Aurora

Peggy@DrPegOnline.com

720-212-4028