Identifying Students with Psychological Difficulties:

How to Look and What to Look For

 

Julia Routbort, Ph.D.

Counseling and Psychological Services

University of Virginia

 

How to look:

 

• Trust your gut. If you experience any sense of unease or concern about a student, it is important to pay attention to those inner signals.
• Use your common sense. You don’t need to be able to officially diagnose someone with Major Depression to know that they are in substantial distress.
• Listen carefully. Many students will have trouble articulating what their real difficulties are. It takes time to establish a relationship and time to understand that the student who appears wanting to change his/her major is also wanting to talk about their sense of confusion/isolation at UVA (for example).
• Consult with colleagues. As college students appear to be increasingly suffering from more serious types of mental illnesses, they will present with more acute needs, more overwhelming symptoms and more complicated family and life circumstances. We all need support and help to work effectively with these types of individuals.

 

 

What to look for:

 

Disturbances in emotional life

 

·        being constantly overwhelmed by feelings, to the point where they rule the student’s life

·        not understanding why feelings are there or why they are so intense

·        being on a roller-coaster of emotions, swinging from sadness to rage and back

·        not being able to distinguish feelings from actions

·        loss of pleasure

·        using alcohol or other substances to medicate feelings

 

Warning Signs for suicidality

 

·        despair, hopelessness

·        pervasive guilt

·        profound feelings of worthlessness or shame

·        anger turned against the self

·        constant sense of failure

·        helplessness

·        sudden improvement in mood (can reflect decision to commit suicide)

 

 

Disturbances in thinking

 

·        seeing or hearing things other people don’t

·        substantially diminished concentration and/or attention

·        paranoia – perceiving others as being “against” him/her

·        substantial memory lapses

·        unusual beliefs involving persecution, delusions of control or magical thinking

·        obsessive, ruminative worries about things the person cannot control

 

Warning signs for suicidality

 

·        preoccupations with death

·        thinking about suicide as a viable option and death as a relief

·        beliefs  about joining a previously lost loved one after death

·        clear mental plans and preparations for suicide

 

 

Disturbances in behavior

 

·        self-destructive impulsivity

·        major changes in sleep, appetite and/or eating habits

·        aggression, either towards the self (e.g. cutting) or others

·        major disruptions in regular routines

·        loss of energy and loss of motivation

·        being “slowed down” or “speeded up.”  Agitated depression is probably the most dangerous form. 

 

Warning signs for suicidality

 

·        any purchase of a weapon

·        exploration of possible means for suicide (e.g surfing web for means)

·        communication about suicide, either direct or veiled

·        increased impulsivity in other areas

·        recklessness, self-destructive behaviors

·        “putting affairs in order”

·        increased substance use

·        previous suicide attempt

 

 

Disturbances in relationships

 

·        Social withdrawal/isolation

·        Aggression or violence in relationships

·        “I’m nothing without you”-excessive reliance on relationships

·        alternating extremes of idealizing “he’s Prince Charming” with devaluation “he’s a piece of…..” without middle ground

·        “I’m here because of my spouse/teacher/friend”. Everyone else is more worried about the person than they are.

 

Warning signs for suicidality

 

·        saying goodbye to others

·        pulling away from others

·        recent loss/rejection

·        family history of suicidality

 

 

What to do if you are worried that a student may be considering suicide–

 

• Ask Directly!!!   Questions such as …

 

“When you feel really down, have you thought about killing yourself?”

“Are thinking about hurting yourself?”

 

… are a very appropriate and effective way of obtaining this important information.  These types of questions will help the student know that you think it is acceptable to share their thoughts and feelings. This sharing is typically a great relief, since many suicidal individuals feel alone and overwhelmed. There is no danger of “planting” the idea of committing suicide in someone’s mind.

 

• Be available. Show interest and offer support.

 

• Take them seriously. If someone talks about suicide, even if it seems like a “joke” or as a “cry for attention”, it is important take them at their word.

 

• Try not to get upset or communicate your own personal judgments.  You may have strong feelings against suicide, but it’s not helpful if you attempt to convey those thoughts or feelings in the midst of the student’s depressive crisis.  Be calm, receptive and serious, conveying that you can tolerate hearing about their painful feelings.

 

• Help them get help. The most effective means of suicide prevention is a referral for professional help.

 

• Also – feel free to call CAPS and ask to speak with the on-call clinician if you would like consultation pertaining to a student you are concerned about

 

 

CAPS Access/Important Numbers

 

Main phone numbers for appointments or for daytime contact with the on-call clinician:  243-5150

924-5556

 

After hours or weekend on-call: ………………………………………………………..         972-7004