Referring Others

For students, college is a time of transition including developmental challenges such as individuating from parents, forming intimate relationships, and establishing a career identity. Students often seek help from others for these concerns, as well as for situational difficulties, e.g. failing a course, losing a loved one, or roommate conflicts. Research shows however, that more severe mental health problems are being manifested among students than in the past. Faculty and staff, especially when in advising and coaching roles, are often the people to whom students first show their difficulties and a need for help through their classroom behaviors, academic performance, or personal disclosures. It is important for faculty and staff to be able to recognize the signs of distress that students show, to know the parameters of their roles as advisors, coaches, and mentors, and to effectively refer students to appropriate mental health resources when needed. Parents and friends, who know a student well, can also detect changes in a student’s behavior that indicate difficulties. Some guidelines and information are provided below to assist in this process of problem recognition and referral for help.

Problem behaviors may be manifest in the classroom, in advising sessions, in living areas, or during informal interactions, among other ways. Faculty and staff who have regular contact with students in these ways are in good positions to assist with early detection and referral. Parents may learn about some of these behaviors through email or phone calls home. Roommates and friends are the day-to-day observers of signs of distress and malfunctioning. It is very important for others to recognize the signs of distress in students. Some examples listed below show a range of problem behaviors that may be indicative of adjustment or mental health concerns.

• Extremely poor academic performance, or a change from high to low grades
• Excessive absences, especially if prior class attendance was good
• Unusual or noticeably changed interaction patterns in the classroom
• Depressed or apathetic mood, excessive activity or talkativeness, evidence of crying
• Noticeable change in appearance and hygiene
• Alcohol on the breath/problem drinking patterns
• Inability to remain awake in class
• Repeated attempts to obtain deadline extensions or postpone tests
• Dependency
• New or continuous behavior which disrupts your class or student interactions
• Inappropriate or exaggerated emotional reactions to situations, including a lack of emotional response to stressful events
• Seeking help from multiple other parties instead of counseling professionals.
• Violent or other extremely disruptive behavior
• Obvious loss of contact with reality
• Disturbed speech or communication content
• Suicidal or other self-destructive thoughts or actions
• Homicidal threats

Symptoms of specific psychological problems

Depression

• Feelings of sadness, helplessness, hopelessness
• Sleeping too much or too little
• Weight gain or loss
• Overeating or loss of appetite
• Loss of interest in sex
• Tearfulness
• Withdrawal from others
• Loss of interest in activities previously enjoyed
• Decreased motivation
• Alcohol or other drug abuse
• Pessimism
• Problems with concentration or memory
• Thoughts of death

Anxiety

• Constantly moving around or being fidgety
• Not being able to relax
• Nervousness
• Physical sensations like heart pounding, feeling dizzy, can’t catch breath, and/or trembling
• Feeling pressured
• Excessive worry
• Unable to make decisions
• Problems sleeping
• Difficulty concentrating

Alcohol abuse or dependence

• Using alcohol to cope with difficulties
• Drinking more often or larger amounts
• Hiding drinking from others
• Gulping drinks
• Getting annoyed with others who comment on how much is used
• Being uncomfortable when alcohol is not available
• Feeling guilty about drinking
• Unsuccessfully being able to cut back drinking
• Drinking more than planned
• Drinking in the morning
• Memory loss, blackouts
• Drinking to feel normal

Anorexia

• Significant weight loss
• Restricted/reduced food intake
• Ritualistic eating patterns
• Denies hunger
• Perfectionistic
• Excessive exercise
• Distorted body image
• Very self controlled
• Does not reveal feelings

Bulimia

• Frequently goes to the restroom after meals
• Mood swings
• Buys large quantities of food that disappear suddenly
• Swelling around the jaw
• Weight may be normal
• Frequently eats large amounts but does not gain weight
• Buys large amounts of food and eats it on the spur of the moment
• Laxative or diuretic use

Thought disorders

• Delusions
• Hallucinations
• Disorganized speech (e.g. incoherent, tangential)
• Disorganized or catatonic behavior

Similarities between Counseling and Advising/Coaching

Some helping roles on campus share certain facets.

• Ongoing process with multiple contacts with student
• Relationship is a key factor in helping
• Focus of the work can be academic, career, or personal in nature
• Goal oriented
• Student development and success are core values

Differences between Counseling and Advising/Coaching

It is important to recognize the differences among counseling, advising and coaching roles to ensure that the student is receiving the most appropriate service from the professional trained to provide it. Professional role boundaries and respecting areas of responsibility and competence are important in this respect. Some of the differences are described below.

• Types of contacts: Counselors typically meet with students once per week for an hour with the directed focus of resolving particular issues. Advisors, coaches, and faculty may meet as needed with appointments lasting a varying amount of time.
• Roles: Advisors, faculty and coaches may interact with their students in multiple roles, for example as a teacher, at a departmental picnic, as the advisor of a student organization, to name a few. This necessitates care in negotiating and clarifying parameters of those interactions with the best interests of the student and avoiding conflicts of interest in mind. In a counseling relationship, multiple relationships are less frequent since they can often interfere with objectivity in the counseling process.
• Responsibility: Advisors, faculty and coaches may initiate contact with a student who has been identified as at-risk academically and therefore in need of service or may routinely initiate contact with students assigned as their responsibility. This places some of the responsibility for the interaction on the faculty or staff member and not just on the student. In a counseling relationship, it is the responsibility of the student to initiate the first contact and agree to the helping relationship, except in the case of emergencies.
• Professional training: Counselors are professionally trained in the diagnosis and treatment of a range of student problems, including situational difficulties, developmental concerns and mental health problems. Some faculty and staff have excellent judgment, intuition and life experiences that may inform interactions with students around similar issues, but they are not professionally trained to address such issues.
• Confidentiality: Counseling is predicated on the principle of confidentiality that is established by law and professional ethics and disclosure of information to third parties without the consent of the client is prohibited. Disclosure of information about students by faculty and staff to professionals within the University who have cause to know and are in professional positions to assist that student is acceptable. 　

When to Refer

Whenever any of the signs of difficulties listed above are present and a student is not functioning at optimum level, a referral to Student Counseling Services could be warranted. Often an empathic listener or a trusted mentor can provide the support, guidance, or perspective to sufficiently help a student through a difficult situation or time in life. Teachers, advisors, Student Affairs staff and university personnel in general, are dedicated to helping students learn, grow and succeed. There are times however, when the help of professionals trained to deal with psychological issues and problems is warranted. Faculty and staff should consider referring a student to Counseling Services in the following situations.

• A student asks for help with a problem outside of your realm of expertise.
• The student feels uncomfortable talking to you about the problems.
• What you have done so far has not sufficiently helped reduce the problem.
• The student’s behavior is disrupting others.
• Helping the student could represent a conflict of interest or dual relationship and compromise your objectivity.
• You are having a strong emotional reaction to the student’s situation, e.g. feeling overwhelmed, overly responsible, afraid, or tired.
• You are extremely busy or stressed, or unwilling or unable to offer the necessary help.

Some aspects of making an effective referral include helping the student see that there may be a problem, showing caring, and instilling a sense of hope and confidence in the remedy through counseling. Specific suggestions for referring are provided below:

• Talk to the student in private.
• Express concern, while being specific about particular troubling behaviors.
• Listen empathically.
• Remain neutral.
• Suggest to the student that it would be helpful to talk to someone at Student Counseling Services who is trained to address his/her concerns. Have the student call to schedule an appointment from your office, if he/she is willing.
• Demystify and destigmatize counseling as necessary.
• Call a counselor yourself to consult about the student’s circumstances.
• Obtain emergency help via University Police if there is a threat of danger or harm.
• Follow up with the student to find out if he/she kept the appointment. Don’t inquire about details of the session, rather just show an interest in knowing that the student is getting the help he or she needs.

Confidentiality Statement

All client contacts and information obtained in the course of treatment is confidential. No information will be released without written authorization from the client, except in the rare cases of imminent danger or as required by law when there is a suspicion of child abuse, elder abuse or a court order.