Rufus Larkin, Lonika Crumb, Yolanda Fountain, Ca Trice Glenn, and Jennifer Smith, Georgia Perimeter College

Mental health issues among college and university students are rapidly on the rise, and these issues are not solely relegated to counseling center offices.  Many students experience psychological, emotional, and behavioral issues in the academic setting (The National Alliance on Mental Illness, 2012; Smith et al, 2007), and these issues are increasingly becoming more prevalent in advisement offices. 

As academic advisors become acutely aware of the clinical and mental health issues that emerge for students (Kadison & DiGeronimo, 2004), they recognize that such issues are not only detrimental to academic success, but also to personal safety.  When some students exhibit severe mental and emotional health issues, it may pose a serious risk to others at their college or university.  Too often, students can face changes and challenges in their personal lives that may interfere with their ability to perform adequately in the academic arena and with their ability to think rationally (Harper & Peterson, 2005).   Unpreparedness for mental health issues in the advisement office may exacerbate any mental health situation into a crisis of any magnitude at any given time.  Thus, the purpose of this article is to support advisors’ efforts with useful information and best practices related to safely preventing, intervening, and managing mental health situations in the advising office via the use of de-escalation techniques and by identifying resources for collaborative assistance. 

Understanding Students with Mental Health Needs 

Student affairs professionals have reported that students from underrepresented groups (e.g., ethnic/racial minorities, religious minorities, lesbian, gay, or queer students) often face additional challenges and pressures in the academic setting that may impact their psychological well-being (Grant et al., 2014; Hyun, Quinn, Madon, & Lustig, 2009; Mier, Boone, & Shropshire, 2009).  These groups may face challenges in the following ways:  a) studying in a predominantly white college or university environment with different educational formats, b) isolation, c) language barriers, d) lack of knowledge about supportive services and resources, and e) cultural biases and prejudices (Hyun et al., 2009; Mier, et al., 2009; Shadick & Akhter, 2013).  Largely, college students from unrepresented groups are at a higher risk for suicide (in comparison to nonminority students), social conflict, depression, and other behaviors that may impact their academic success (Grant et al., 2014; Shadick & Akhter, 2013).  Without awareness and knowledge, these barriers can trigger major mental health reactions and conditions, which often reflect poorly in retention and graduation rates for culturally diverse students (Muses & Ravello, 2010).

Recent survey information from experts in advising and counseling suggest that it is important for advisors to know how to properly manage mental health situations in the office.  According to Van Pelt (2013) and Kitzrow (2009), the top mental health issues identified in a survey of over 750 college students were depression, anxiety, suicide ideation, eating disorders, and addiction issues.  Invariably, these mental health issues are what advisors are most likely to see.

Building upon a mental health management concept, advisors need to be prepared for the prevalence of severe psychological issues among students.  Generally speaking, the college or university landscape represents the following (NAMI, 2012):

• 25% of a total college population of students will have a mental health issue;
• 40% of this population does not seek any counseling services;
• 80% find themselves overwhelmed at some time or another during matriculation; and
• 50% experience intense anxiety as they struggle in school.

Categorically, students report to college campuses nationwide with formal diagnoses and with prescribed medications.  Others report to campuses as undiagnosed students who are in need of psychological services and resources, while others report intentional noncompliance with psychotropic medications (Watkins, Hunt, & Eisenberg, 2012). 

Crisis Prevention in the Advisement Office 

Preventing a crisis is predicated on the application of strategies that are rooted in problem-solving techniques.  Although the rudimentary skills of empathic listening and positive reflection are essential to managing a crisis situation, the primary focus is on de-escalating the situation and connecting students with needed resources (Mier et al., 2009).

Conceptually, the initial focus of engagement with students is to establish a sense of trust, management, and advocacy, while targeting the mild-to-elevated levels of generalized risk and agitation in behavior (The National Behavioral Intervention Team Association, 2009).  According to Harper and Peterson (2005), while most advisors may not be licensed professional counselors, they are in an excellent position to do what they do best:

• Observe and assist students who are experiencing distress and serious mental health meltdowns.
• Effectively respond to students experiencing mental health issues in their office with campus resources and referrals.
• Know the names, locations, phone numbers, and contact information of campus psychologists, counselors, and public safety personnel.
• Become active members and participants of the Behavioral Intervention Team (BIT) at their college or university campus.
• Prepare for these situations through professional development opportunities presented in staff development trainings at their institution, or via NACADA workshops or breakout sessions.

As advisors assist students in coping with severe emotional concerns beyond the concerns of advisement, there are a few things to know and consider as a main responsibility.  Harper and Peterson (2005) delineated the following:

• When mental health situations occur in the office, remain calm (i.e., soft tone of voice and facial expression) and assess the situation for student’s risk of harm to self or others.
• Secure the office environment to maintain safety for students and staff.  It is prudent to relocate students experiencing mental health issues away from the main office area to another available office space, a conference room, or secluded area for privacy.
• The goal is to assist and protect students from shame, ridicule, or embarrassment.
• Be aware of the proper points of contact, and refer students to those who can assist them immediately.
• Contact the appropriate resources as the identified and preferred method of resolving the issue (e.g., Personal Counseling Services, Public Safety Department, or Student Health Services).
• Be familiar with other campus resources that may provide complementary support later on (e.g., Health and Wellness Programs, Disability Services, Learning & Tutoring Centers, Mentoring Programs).

De-escalation Techniques 

Every academic advisor, student affairs counselor, or administrative secretary should have in their arsenal the knowledge and training for when and how to use de-escalation techniques.  While the following information is not a comprehensive coverage of the process, it is sufficient for informing the readers of proper protocol.  Further training is highly recommended.

De-escalation is a technique used during a potential mental health situation that aids in preventing a student or other individual from engaging in escalating disruptive or harmful behaviors.  Prevention and communication are two important aspects of de-escalation (Dufresne, 2003).  The focus is on controlling the self with an emphasis on providing undivided attention, displaying a nonjudgmental attitude, focusing on the individual’s feelings, allowing silence, clarifying messages, developing a feasible plan with the individual, using a team approach, recognizing personal limits, and debriefing with a trusted colleague after a major incident (Dufresne, 2003).  Logical and rational reasoning with an emotionally-charged person is not the premise behind de-escalation.  Key factors associated with increasing advisor effectiveness during the de-escalation process, include the following (McClellan, 2005):

1. Self-control:
   1. Behave in a manner that is calm, centered, and self-assured
   2. Use respectful communication with students
   3. Be aware of resources available for back up, including office colleagues
   4. Refrain from reacting defensively, even in the face of direct criticism or insults
   5. Calmly decide to leave the situation if de-escalation is not working
2. Appropriate physical stance:
   1. Maintain at least three feet of distance between the self and the student
   2. Be at the same eye level as students (either sitting or standing)
   3. Refrain from physically touching students in an agitated state
   4. Be aware of exits
   5. Create an atmosphere of relaxation by maintaining periodic (not constant) eye contact
3. Communication:
   1. Set the proper tone for communication with students by speaking in a soft and calm tone, not yelling or screaming at them
   2. Respond appropriately and selectively to students via answering informational questions and not abusive ones
   3. Provide students with choices and alternatives whenever possible
   4. Empathize with the emotional feelings of students, but not with disruptive behaviors (i.e., I understand that you feel angry, and your threatening behaviors will not be tolerated.) 

Resources for Collaborative Assistance 

Effective management of student mental health issues that occur in the advising office require not only that advisors be familiar with utilizing helpful de-escalation techniques, but also with college and other institutional resources.  These resources may exist on college or university campuses as:

• Personal Counseling or Psychological Services
• Behavioral Intervention Teams or Student Intervention Teams
• Department of Public Safety
• Student Health Services
• Disability Services
• TRIO Student Support Services
• Health, Wellness, & Recreation Programs
• Learning and Tutoring Centers
• Mentoring and Leadership Programs

In summary, it is essential that advisors pay close attention to students with mental health needs, prepare to engage in crisis intervention, know how to utilize de-escalation techniques, and be aware of the appropriate resources available on campus to safely prevent, intervene, and manage mental health situations in the advising office. 

Rufus Larkin, Ph.D., LCSW, LPC, ACS; Rufus.Larkin@gpc.edu 
Lonika Crumb, Ph.D., LPC; Lonika.Crumb@gpc.edu
Yolanda Fountain, Ph.D., LPC, NCC, RPT, ACS; Yolanda.Fountain@gpc.edu
Ca Trice Glenn, Th.D., LPC, ACS, NCC; CaTrice.Glenn@gpc.edu
Jennifer Smith, M.S., LPC; Jennifer.Smith2@gpc.edu
Personal Counselors
Advising, Counseling, and Retention Services
Georgia Perimeter College

References 

Dufresne, J. (2003). De-escalation tips. Retrieved from http://www.crisisprevention.com/Resources/Knowledge-Base/De-escalation-Tips/

Grant, J. E., Odlaug, B. L., Derbyshire, K., Schreiber, L. N., Lust, K., & Christenson, G. (2014). Mental health and clinical correlates in lesbian, gay, bisexual, and queer young adults. Journal of American College Health, 62(1), 75-78.

Harper, R. & Peterson, M. (2005). Mental health issues and college students. NACADA Clearinghouse of Academic Advising Resources. Retrieved from http://www.nacada.ksu.edu/Resources/Clearinghouse/View-Articles/Mental-health-issues-in-advising.aspx

Hyun, J., Quinn, B., Madon, T., Lutsig, S. (2007). Mental health need, awareness, and use of counseling services among international graduate students. Journal of American College Health, 56(2), 109-118.

Kadison, R. & DiGeronimo, T. F. (2004). College of the overwhelmed: The campus mental health crisis and what to do about it. San Francisco, CA: Jossey-Bass.

Kitzrow, M. A. (2009). The mental health needs of today's college students: Challenges and recommendations. NASPA Journal, 46(4), 646-660.

McClellan, J. L. (2005). Increasing advisor effectiveness by understanding conflict and conflict resolution. NACADA Journal, 25(2), 57-64.

Mier, S., Boone, M., & Shropshire, S. (2009). Community consultation and intervention: Supporting students who do not access counseling services. Journal of College Student Psychotherapy, 23(1), 16-29.

Muses, S. D., & Ravello, J. N. (2010). Characteristics of academic advising that contribute to racial and ethnic minority student success at predominantly white institutions, NACADA Journal, 30(1), 47-58.

Shadick, R. & Akhter, S. (2013). Suicide prevention in a diverse campus community. New Directions for Student Services, 2013(141), 71-81. doi: 10.1002/ss.20041

Smith, T. B., Dean, B., Floyd, S., Silva, C., Yamashita, M., Durtschi, J., & Heaps, R. A. (2007).  A survey of American College Counseling Association members. Journal of College Counseling, 10(1), 64-78.

The National Alliance of Mental Illness (2012). College students speak: A survey report on mental health. Retrieved from www.nami.org/namioncampus

The National Behavioral Intervention Team Association [NaBITA]. (2009). NaBITA threat assessment tools. Retrieved from https://nabita.org/resources/threat-assessment-tools/

Van Pelt, J. (2013). College mental health initiatives: Outreach to at-risk students. Social Work Today, 13 (4), 26.

Watkins, D. C., Hunt, J. B., & Eisenberg, D. (2012). Increased demand for mental health services on college campuses: Perspectives from administrators. Qualitative Social Work, 11(3), 319-337

Cite this article using APA style as: Larkin, R., Crumb, L., Fountain, Y., Glenn, C., & Smith, J. (2015, June). Managing mental health situations in the advising office. Academic Advising Today, 38(2). Retrieved from [insert url here]