1109Cov
THE
BULLETIN
Volume 77 | Issue 6
November 2009

Union and activities professionals' role in campus mental wellness

Melissa Filkowski

Recent homicides, suicides, and other tragedies have brought campus mental health issues into the spotlight, and higher education is being challenged to respond. Conflicting laws, lack of knowledge about mental health, and a fear of further catastrophes make this a difficult responsibility. The end result may be confusion for those trying to help and make decisions regarding students with mental
health concerns.

In a 2005 National College Health Assessment, 45 percent of college students reported being so depressed they could not function, and 11 percent of females and 9 percent of males said they had seriously considered suicide. Beyond depression and suicidal tendencies, mental wellness encompasses a broad spectrum of psychological, neurological, and learning differences that can impact a student’s ability to succeed in school and manage daily tasks. Mental illnesses may result from day-to-day stressors that escalate into overwhelming concerns, such as financial or academic problems. According to the National Institute of Mental Health, one in five adults in the United States has a diagnosable mental illness. This 22.1 percent likely includes campus community members, many of whom are suffering in silence. Despite not knowing the cause, colleagues, fellow students, faculty members, and administrators must compensate for afflicted individuals’ difficulties performing work, solving problems, and interacting with others.

The term “mental wellness” is not meant to infer that students with these differences are “unwell” mentally but to work toward an umbrella concept that is inclusive of diverse needs and the opportunities for campuses to help these students reach optimal functioning. Campuses can be proactive in creating a campus that values mental wellness. This process begins by assessing the institution’s procedural structure for managing mental health concerns, and then ensuring those who work most closely with students—such as college union and student activities professionals—are trained to appropriately manage problems.

Campus-wide preparation and response

It is not surprising that experts recommend implementing a system-wide approach to addressing campus mental health. More difficult, however, is conceptualizing what exactly this means and then effectively implementing systemic solutions. Utilizing theoretical foundations that deal with systems is one way to help those involved with promoting student mental wellness and responding to crisis appropriately. Both the fields of business as well as marriage and family therapy provide useful frameworks for looking at organizations systemically. By applying these contexts to campuses within the framework of mental health, solutions become apparent.

Systems theory indicates that each part affects the whole. Bridging this concept to the campus level, it can be said that the work that goes on in the college union affects and is affected by other parts of the system (e.g., student housing or the math department). For example, a student experiences a disagreement with a faculty member. He then comes to a student government meeting where he holds an office as student body vice president. In sharing this frustration with fellow students and campus employees, these listeners have a choice in how to respond to the student’s frustration. A response can be made that escalates the problem (“Oh yeah, he’s a horrible professor.”). Or, support can be given to the student to help the system better function. These types of responses would include helping the student understand the complaint process and providing campus resources for successful mediation or resolution.

Another application is a shift from a traditional mental health perspective that focuses on the “identified patient” to a broader context, focusing on interactions and relationships within the system—in this case, the university campus. This is not to blame the system for creating mental health problems but to maximize each member’s ability to improve the function of the whole. Therefore, an overarching objective for campuses is to create a highly functional system.

So, how do campus community members work to create highly functional systems? Functional systems are those that have a clear and coordinated structure and that exude a culture of caring. A simplistic formula follows:

Structure: Incorporates clear policies, procedures, and effective programs. Behavior expectations are clearly outlined and immediately, progressively, and consistently addressed when infractions occur. All campus employees know these policies and the expectations and procedures for communication and enforcement.

Caring culture: All campus members understand their campus’s vision for mental wellness and their role in meeting that vision. Training is done so that campus members know how to address concerning student behavior. Campus members practice self-care and model positive mental health habits.

Experts in the field of campus mental health and violence prevention encourage campuses to develop a communication plan and procedures for addressing students with concerning behavior. Ideally, a multidisciplinary team will be created that allows for planning, communication, problem solving, and response to issues of concern. As each campus is unique, these members may vary according to need. The participants could include security and law enforcement, mental health professionals, faculty members, legal counsel, classified or service employees, and administrators from appropriate areas such as student services, instruction, and human resources. College union professionals are ideal participants due to their roles as student employee supervisors and student organization advisors. The plan should include training and publication of the phone number, location, and procedures for reporting concerns.

Union and activities professionals are in an excellent position to participate in the improvement of campus mental wellness. Many already provide programming and education that help students understand their own and their friends’ mental health. Opportunities to laugh and connect with others are important components of the campus system. These same activities also are promoted by colleagues in the counseling profession, providing rich opportunities for cross-campus partnerships.

Legal considerations
In an effort to balance students’ rights and responsibilities and those of the higher education institution, federal and state laws come into play, along with campus policies, procedures, and regulations. The following section briefly highlights a few issues that pertain to campus professionals working with students. As state laws and campus decisions vary, please seek clarification directly from the administration and legal counsel of the institution.

Right to refuse treatment
Adults with mental health problems have the right to refuse treatment, unless they are deemed gravely disabled or a threat to themselves or others. Only certain designated individuals have the authority within a given state to make these decisions. These are most often not campus employees, and therefore, processes for student emergencies should be clearly outlined. Campus professionals may be responsible for student safety, yet may not have the authority to effectively maintain a safe environment.
From a therapeutic standpoint, it is helpful for campuses to discuss the benefits and challenges associated with requiring treatment. Counseling is not simply a matter of listening to problems and making suggestions, but a high-level process that also involves commitment and work done by the client.  Changes in behavior and ways of thinking can only happen when the client actively participates in the therapeutic process. Similarly, students may choose not to take medication that improves their condition. Some campuses are moving to a case management approach that requires at-risk students to check in regularly with a campus professional.
 
Duty to warn/protect
As a legal response to a campus tragedy that occurred in the 1970s, the Tarasoff v. Regents of the University of California citation has become one of the standards for mental health providers regarding disclosure of information. The “duty to warn” exists when a mental health practitioner directly learns of potential harm to an individual, group, or property. In his presentations about legal issues related to mental health, clinical social worker and psychologist Patrick DeChello specifies the need for: “Direct knowledge of:

1. The client’s propensity to commit violence,
2. The client has the intention to inflict physical injury, and
3. The client has named a specific person or group.”

DeChello also notes that this duty to warn requires that practitioners make a timely effort to seek commitment of the client, take treatment action that eliminates the threat, or inform the police and identified victims. These are standard exemptions to the confidentiality laws governing the work of mental health and health care practitioners, but administrators should be aware of any particular state statutes that affect confidentiality decisions.

FERPA/HIPAA
Colleges are faced with different sets of laws related to confidentiality. These different laws can create complications in the ability to effectively communicate between campus authorities. The Federal Educational Rights and Privacy Act (FERPA) covers a student’s educational records, while the Health Insurance Portability and Accountability Act of 1996 (HIPAA) covers confidentiality expectations that govern the work of health care professionals, including counselors. Campus staff may become frustrated that counselors will not disclose information about students they referred to services. Opinions differ on the status of records kept in a disability services office, which contain both academic and health information. Debate continues on these policies and how they relate to confidentiality, parental notification, and student mental health.

ADA
The Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973 paved the way for individuals with physical, psychological, and learning disabilities to receive the services and accommodations that would allow them to access and succeed in education as well as their nondisabled counterparts. Colleagues in academic affairs and disability support services are working to address the growing number of students with “hidden disabilities” such as psychological or learning disabilities. The accommodations for these students are not always as straightforward as for those with physical disabilities.

Opportunities abound by connecting with the counseling center staff and the disability support staff to learn about additional needs for programming, activities, and support. For example, students on the autism spectrum may have challenges with social interaction, although they may very much desire these opportunities. Another example is that many students diagnosed with attention deficit hyperactivity disorder (ADHD) may find the biggest challenge in succeeding in school is not academic, but their executive function (daily living) skills. By bringing the union’s programs and services together with the expertise of counselors and disability support services, there is a tremendous potential for improving a campus’s response to mental wellness.

Scope of practice
“Scope of practice” is a term used by health care professionals, including counselors and other mental health professionals. In short, licensure in these fields requires that practitioners do not work beyond what their training and experience allow. To practice beyond one’s scope not only puts their patients at risk, but also puts the practitioner at risk for legal action. Similarly, campus members not working as counselors, physicians, or others expected to engage in mental health assessment and treatment put students at risk and may be liable for legal action if performing work deemed as therapeutic. This is especially important to remember when students disclose problems and request advice from an activities advisor or work supervisor. The university may not support staff members found to be practicing out of their scope of practice—in this case, a documented job description. Clarifying roles and responsibilities of each campus professional will assist in the ability of the system to function at its best.

Union and activities professionals as first responders
A view of campus interaction patterns illustrates that most student contact happens with others than those traditionally responsible for campus mental wellness. These individuals—referred to as “first responders” or “gatekeepers”—often have a relationship with students, are able to observe behavioral changes, and are the very individuals that these students are likely to turn to when a problem arises. By the time administrators become involved with students experiencing mental health issues, it is often in the complaint or student discipline processes. Those with the best day-to-day relationships with students are club or activity advisors, employee supervisors, faculty members, residence hall professionals, and coaches. Therefore, campuses have a responsibility to train personnel to deal effectively and appropriately with students experiencing mental health problems.

The C.A.R.E. method is “mental health first aid” and provides some information and guidelines for those interacting with students with whom they are concerned. This system was developed specifically to address the concerns regarding training in assessment and referral, role clarification and legal mandates, while promoting a critical “community of caring” culture.

Connect
Renowned therapist and educator Michael Gurrian suggests that education systems be seen as part of a “third family” for students: respected adults who act as caring mentors, who set expectations, provide discipline, and act as role models. Based on his studies of various cultures around the world, he proposes that healthy adults result from authentic communities of diverse individuals working together to initiate young men and women into the expectations of adulthood. Adult and graduate students often deal with adult challenges and transitions such as divorce, pregnancy, loss of job, and difficulties with children. Similarly, for the many adult professionals within the college, these communities of support can play a vital role as well.

Mental health problems can diminish a person’s ability to connect with others, leading to isolation and further risk for problems. When campus members notice a student who appears to be struggling or behaving oddly, it is best to initiate a connection and offer to help. If students are willing to engage in conversation and disclose their problems, the campus member can offer assistance first by showing genuine concern for the student and then by providing information on campus resources and system navigation.

Instead of focusing on a “diagnosis,” gatekeepers should articulate their concerns in terms of observable behavior. A union programming board advisor may state something like, “I have noticed that you seem distracted during meetings lately. Your success is important to me.” If a student is willing to articulate his or her concerns, first responders can then be most helpful when they:

  • Don’t judge the student’s experience
  • Don’t moralize or argue
  • Do ask direct questions, such as, “Are you thinking about killing yourself?”
  • Do take threats seriously

Assess
Student concerns are often vague and may progress over the course of weeks. It is helpful for gatekeepers to have in mind a set of questions to assess the level of risk that corresponds to the level of response. Such questions might include:

  • Is the student a threat to himself or others? If so, is there an indication of how immediate the threat is?
  • Is the student disruptive to other students? Is the behavior simply odd, or is it impacting the learning process or work environment?
  • Is this the first time the problem has been noticed/addressed with the student or has it become an ongoing problem?

When the situation concerns a student employee, job expectations and consequences also should be added into the assessment and following expectations section.

For assessment purposes, students may be categorized into one of three levels:

  • Level 1: Mild, first-time concerns
  • Level 2: Moderate and/or ongoing concerns
  • Level 3: Severe and immediate threatening behavior


Each campus should have outlined procedures and resources for notifying the appropriate office or team responsible for oversight. This team can track ongoing concerns or multiple, minor concerns coming from different areas of campus about the same student.

Refer
Referrals should be based on the assessment screening done during the assessment. Knowledge of campus resources, such as tutoring, financial aid, and special programs—is critical to help students get the services they need to be successful. Counseling programs can help students develop protective factors and coping skills. Gatekeepers need to not only know about these services but also to feel comfortable encouraging students to seek help.

In addition to campus resources, it is important to be cognizant of various cultural mores about seeking help. Ask the student where they have found helpful support (e.g., family members or religious leaders). College union and student activities professionals can be ambassadors to connect students with counselors trained to appreciate and work effectively with diverse clients.
expectations

First responders need to understand how and why to set expectations for the students about whom they are concerned. Focus on the specific behavior. Consequences must also be clarified and executed. Expectations need to comply with campus policies and the campus member’s job expectations. Again, if an incident is related to a student employee, then those expectations must be outlined as well. Thinking about expectations also provides an opportunity to check personal boundaries to ensure an appropriate level of involvement in the situation and a reminder of the expectation of self-care during these difficult situations.

Creating a culture that values mental wellness
In addition to being effective mental health first responders, union and activities professionals can continue to help improve campus mental wellness by following some general suggestions:

  • Know campus and community resources.
  • Encourage students to connect and/or develop a support network.
  • Watch for red flags. These include students who repeatedly approach a campus member for help and may make statements such as, “You are the only one who understands and helps me.” These students may be resistant to receiving needed treatment and can cause turmoil within the system.
  • Reduce stress by clarifying behavioral expectations for students. Enforce consequences immediately and consistently.
  • Set, clarify, and enforce personal boundaries to improve the mental wellness of all involved.
  • Promote a campus culture of self-care, particularly the need for adequate sleep.
  • Set a good example. As each individual in a system affects the whole, address one’s own mental health needs when necessary.

Union professionals play an important role in creating positive culture shifts on campus. Already, a great deal of work has been done to improve a deep respect and appreciation for all campus members. Mental health should be part of this broad goal. By working to create a campus climate where individuals are cared for as unique and valued, there is an improved chance of responding to crisis effectively and promoting a campus culture that encourages positive growth of each of its members.