Transcript 投影片 - 中央大學－諮商中心

Help Students with Mental
Illness Success in Campus
ChunLin J. Ju, Psy.D.
November 28, 2007.
Instructor: 朱春林博士 ChunLin J. Ju, Psy.D.
學 歷：佛瑞斯特專業心理學院臨床心理博士班畢業 (Doctorate in clinical
psychology in Forest Institute of Professional Psychology, MO, USA)
執 照：臨床心理師 (心理字第000651號)(Licensed Clinical Psychologist)
現 職：臨床心理諮詢顧問、督導
新竹教育大學教育心理暨諮商心理系／所兼任助理教授
清華大學學生諮商中心兼任臨床心理師
興 趣：兒青心理病理、注意力缺陷與過動症、適應障礙、自閉症、妥瑞氏症、焦慮
症、憂鬱症、躁鬱症、人格疾患、心理諮詢、心理治療、心理衡鑑、專業倫
理、遊戲治療、砂盤治療、催眠、哀傷諮商、女性主義、談判協商、性／別／
性取向議題
經 歷：西肯塔基州立精神病院 (Doctoral Intern, Western State Hospital, KY, USA)
培尼羅伊心理健康中心兒青診所、成人診所 (Doctoral Intern, Pennyroyal
Mental Health Center, Children’s Clinic, Adult Clinic, KY, USA)
佛瑞斯特學院診所 (Psychological Trainee, Forest Institute Clinic, MO,
USA)
交通大學學生諮商中心、台積電、世界先進、外貿協會特約心理治療師
青輔會、北市勞工局特約生涯諮商師
新竹教育大學、文化大學、與多所企業講師
聯 絡：(02)2215-4092
[email protected]
Dr. Juno Ju
2
Topics Covered
Introduction of mental illness
Common mental disorders in campus
Accommodation to special needs of
these students
Q&A
Goals:


Identify the signs of individuals in distress
Take the appropriate steps to get help
Dr. Juno Ju
3
What is Mental Illness?
Mental illness is a term that refers
collectively to all diagnosable mental
disorders causing severe disturbances in
thinking, feeling, relating and functional
behaviors
These disorders result in substantially
diminished capacity for coping with the
ordinary demands of life
Dr. Juno Ju
4
What is Mental Health? (cont’d)
精神衛生法第三條：


精神疾病係指個體的思考、情緒、知覺和認
知等精神狀態異常，致使適應生活的功能發
生障礙，而需要醫療與照顧的疾病，包括精
神病、精神官能症、酒癮和藥癮等衛生主管
機關認定之精神疾病。
精神疾病 = 心理疾病
Dr. Juno Ju
5
What is Mental Health? (cont’d)
Well Adjusted
Mentally Ill
Reasonably worryfree
Frequently and
severely worry-bound
Can handle the
usual daily tensions
and crises of living
which may involve
moments of fear,
anxiety, distrust,
depression
Tends to exaggerate
these same thoughts
and feelings of fear,
anger, anxiety, distrust
and depression
Dr. Juno Ju
6
Therapeutic Recreation
Mental Illness
Mental Retardation
Can be temporary
Occurs most often n
early adult and
middle years
Does not necessarily
interfere with strictly
intellectual abilities
Often can be cured
by counseling,
medication, surgery
Is usually lifelong
condition
Occurs at or near
birth and almost
always recognized
by school age
Is characterized by
impaired intellectual
development
Treatment through
therapy but not
cured
Dr. Juno Ju
7
Prevalence
Mild mental illness conditions are
common
1/5 of Americans experience some
diagnosable mental disorder during any
given year
Anxiety disorders are most common
Depression affects 1 in 10 adults
3% experience severe and persistent
mental illness
( American Psychiatric Association, 2005)
Dr. Juno Ju
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Signs of Problems
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
Dr. Juno Ju
9
Signs of Problems (cont’d)
New or continuous behavior which disrupts
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
Marked personality change
Dr. Juno Ju
10
Depression
Mood disorder
Depressed mood or loss of interest/pleasure
over long period:

2 weeks vs. 2 years
Emotional:

Depressed, anhedonia
Somatic:

Appetite, weight, sleep, sexual, energy disturbance
Behavioral:

Psychomotor agitation/retardation
Cognitive:

Distraction, indecisive, low self-esteem, guilty,
worthless, suicidal Dr. Juno Ju
11
Bipolar Disorders
Mood disorder
Mania + depression
10-15% completed suicide
Mania:


Grandiose, euphoric, elevated, expansive, or irritable
mood lasts for one week vs. four days
Mood:
• as above

Somatic:
• Abnormal sleep and energy

Behavioral:
• Pressure of speech, goal-directed or pleasurable
activities

Cognitive:
• Flight of ideas, distractibility
Dr. Juno Ju
12
Bipolar Disorders (cont’d)
Bipolar vs. Schizophrenia:



Variability of content
Dramatic response to mood regulators
3-generation family history for mood
disorder
Bipolar vs. ADHD:


Most manic kids meet ADHD criteria
20% of those with ADHD symptoms meet
mania criteria
Dr. Juno Ju
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Suicide
The 2nd leading cause of death for
college students is suicide
(Jed Foundation, 2005)
One out of every 12 college students
has made a suicide plan
(Mental Health America [Formerly known
as National Mental Health Association], 2007)
Dr. Juno Ju
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Danger Signals for Suicide Risk
Talking about death or suicide
Feelings of hopelessness
Withdrawing from friends and social activities
Taking unnecessary or life-threatening risks
Giving away personal possessions
Losing interest in personal appearance
Increasing use of alcohol or [other] drugs
Having attempted suicide in the past, however
half-heartedly (Kadison & DiGeronimo, 2004)
Dr. Juno Ju
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Anxiety Disorders
Generalized Anxiety Disorder

Excessive worry in general
Obsessive-Compulsive Disorder

Consuming fixation and ritualistic behaviors
Panic Disorder

Overwhelming physiological event
Social Phobias

Incapacitating fear of social interactions
Specific Phobias

Intense fear of specific object, event
Dr. Juno Ju
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Post Traumatic Stress Disorder
Anxiety Disorder
Exposure to traumatic event
reexperience: Flashbacks
Passively avoiding reminders: Numbing
of affect, dissociative amnesia
Heightened general arousal
Duration of disturbance: One month
Dr. Juno Ju
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Attention-Deficit/Hyperactivity
Disorders (ADHD)
Inattention
Hyperactivity
Impulsivity
Age of onset: Before 7 years
Symptoms last for at least 6 months
Seen in two or more settings

70% of childhood cases persist into
adolescence and 65% of adolescent cases
persist into adulthood, although some
symptoms may improve/change
(Barkley et al., 2004)
Dr. Juno Ju
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Tic Disorders
Tics: Sudden, brief,
involuntary or semivoluntary
movements (motor
tics) or sounds
(vocal tics)
Tourette’s Disorder:


Both multiple motor
and one or more
vocal tics
Onset before age
18 years
Dr. Juno Ju
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Schizophrenia
Most serious mental illness
Active-phase symptoms: One month




Thought disorganization: Delusions,
hallucinations
Speech disorganization: Incoherence,
derailment,
Behavioral disorganization: Catatonic,
bizarre,
Negative symptoms: Anhedonia, flat of affect,
alogia, avolition, associality
Social/Occupational dysfunction
Duration of disturbance: 6 months
Dr. Juno Ju
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Personality Traits or Disorders
Inflexible and pervasive enduring pattern
of inner experience and behavior in:

Cognition, affectivity, interpersonal
functioning, impulse control
No particular psychosis or suffering and
usually normal behavior, but can result in
anti-social acts without sense of guilt
E.g., Borderline Personality Didorder
Dr. Juno Ju
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Relationship Violence
Violence against women on college campuses is
widespread (B. Fisher, F. Cullen, M. Turner, 2000)
The highest rates of relationship violence are among
women 16-24 years of age (U.S. Department of Justice, Office of Justice
Programs, 2001)
13% of surveyed students reported experiencing an
emotionally abusive relationship the last school year
(American College Health Association, National College Health Assessment, 2006)
Over half of all stalking victims are 18-29 years (U.S.
Department of Justice, Office of Justice Programs, 1998)
Midwest University Study: The number of students
seen in response to sexual assault quadrupled (Kansas
State University Study (1989-2001) of 13,257 students, cited in: Benton, Robertson, Tseng, Newton, & Benton,
2003, p. 69)
Dr. Juno Ju
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Functional Limitations of
Mental Illness
Screening out environmental Stimuli
Sustaining concentration
Maintaining stamina
Handling time pressures and multi-tasks
Interacting with others
Fear of authority figures
Responding to negative feedback
Responding to change
Severe test anxiety
Dr. Juno Ju
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Causes of Mental Illness
Heredity
Psychological
Physical
Environment
Dr. Juno Ju
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Treatment of Mental Illness
 How



Psychotherapy: Individual or group
Milieu therapy: Environmental change
Medical treatment: Drug therapy
 Who

Psychiatrists, clinical psychologists
 Where

Mental hospitals, private practice, mental
health clinics, health centers, general
hospitals, campus counseling centers
Dr. Juno Ju
25
Medication
Take much longer time to take effect
Side effects:









Nausea
Drowsiness
Fatigue
Excessive thirst
Blurred vision
Hand tremors
Initiating Interpersonal contact
Loss of appetite, sexual interest
Weight gain
Dr. Juno Ju
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Steps In Responding
Steps In Responding
 Recognize
signs
 Assess
impact
 Identify
strategies to assist
 Refer
Dr. Juno Ju
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When to Refer (professional staff)
A student asks for help with a problem outside
of your realm of expertise
The student feels uncomfortable talking to you
about the problem
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
You are having a strong emotional reaction to
the student’s situation
You are extremely busy or stressed, or unable
help
Dr. Juno Ju
29
How to Refer
 Talk to the student in private
 Express concern, while being specific
 Listen empathically
 Remain neutral
 Suggest that it would be helpful to talk to a trained
professional at the Counseling Center
 Have the student call to schedule an appointment from
your office
 Demystify and de-stigmatize counseling
 Call a psychologist or counselor to consult
 Obtain emergency help via Campus Safety if there is a
threat of danger or harm
 Follow up with the student to find out if he/she kept the
appointment
Dr. Juno Ju
30
Accommodation
Removal of Barriers
to Participation
The emphasis is on ACCESS,
NOT on outcome
Dr. Juno Ju
32
Laws Requiring Reasonable
Accommodations
1973 Rehabilitation Act, Section 504
1990 Americans with Disabilities Act
Dr. Juno Ju
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Principles of Accommodation
Address individual needs
Respect student’s desire for confidentiality
Engage in joint problem solving
Make all accommodations voluntary
Review accommodations periodically
Be flexible in enforcing policies
Identify accommodations clearly
Dr. Juno Ju
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Accommodations Are NOT
Reasonable if They...
Pose a direct threat to the health or
safety of others
Make substantial changes in essential
elements of the curriculum
Require substantial alteration to
educational opportunities/course
objectives
Pose undue financial or administrative
burden
Dr. Juno Ju
35
Strategies for Inclusion in College
Teach to various learning styles: Visual,
auditory, kinesthetic
Increase experiential learning activities
Increase knowledge and acceptance of
mental illness
Be prepared to set behavioral limits
Know campus mental health resources
Work cooperatively with students
Assist students with time management
Dr. Juno Ju
36
Possible Classroom
Accommodations
Preferential seating, near door
Assigned classmate as assistant
Beverages permitted
Prearranged or frequent breaks
Tape recorder, note taker
Early availability of syllabus, text
Text, assignments in alternate formats
Personal and private feedback
Dr. Juno Ju
37
Possible Examination
Accommodations
Change in test format: Written to oral
and vise versa, dictation, scripted, typed
Permit use of computer software
Exams in alternate format: Portfolio, demo
Extended test taking time
Individual proctoring
Separate, quiet room for testing
Increased test frequency
Dr. Juno Ju
38
Possible Assignment
Accommodations
Substitute assignments in specific
circumstances
Advance notice of assignments
Allow assignments hand written
Written rather than oral, or vise versa
Change format: Drama, role-play, sculpture
Assignment assistance: Ask
Extensions on assignments
Dr. Juno Ju
39
Campus Safety
Campus Safety
All colleges must guarantee learning
environments that are safe and secure
Student mental health emergencies may
bring unrest and harm to the student in
distress, other students, and
faculty/staff/administration
College educators are mandated
reporters for child abuse
Examples: Suicide attempts, incidents of
stalking, sexual assault, domestic
violence, and substance abuse
Dr. Juno Ju
41
Behavioral Issues &
Student Conduct
All students must abide by the student
code of conduct
Perform behavioral assessment to
determine if a student is in emotional
crisis, is responding to a real-life crisis
situation or is being disruptive
Identify and refer those in emotional
distress to a mental health professional
Identify and refer those who are just
“acting out” to campus disciplinarian
Involve police when safety is threatened
Dr. Juno Ju
42
Mandatory Hospitalization
精神衛生法第21條：




嚴重病人如有明顯傷害他人或自己之虞，或
有傷害行為時，經專科醫師診斷有全日住院
治療之必要者，前往精神醫療機構辦理住院
前項嚴重病人不接受全日住院治療時，應由
兩位以上專科醫師鑑定，經書面證明有全日
住院治療之必要者，應強制其住院；其強制
住院，應在中央衛生主管機關指定之精神醫
療機構為之。
前項鑑定，以全日住院方式為之者，其住院
鑑定期限，以七日為限
強制住院治療需要有合作的精神專科醫院，
並通知當地衛生主管機關
Dr. Juno Ju
43
Concluding Remarks
Concluding Remarks
It is critical to develop a campus-wide
cultural climate that de-stigmatizes
mental illness, removes barriers, and
encourages help-seeking behavior
Sensitivity and awareness training is
imperative for administrators, faculty,
staff, and student workers
Dr. Juno Ju
45
Concluding Remarks (cont’d)
Interventions aim at:


Supporting student success
Assisting in protecting the health, safety,
and welfare of the students and members of
the campus community
Dr. Juno Ju
46
Reference
 ADA: American Disability Association
 Anxiety Disorder Association of America (http://www.adaa.org/)
 AHEAD (http://www.ahead.org)
 Al Souma. Accommodating students with psychiatric
disabilities. Disability Support Services. Seattle
Central Community College. DO-IT, University of
Washington
 Center for Psychiatric Rehabilitation Sargent College
of Health and Rehabilitation Sciences (http://WEB.bu.edu/sarpsych)
 DO-IT The Faculty Room (http://www.washington.edu/doit/faculty/)
 Judge Bazelon Center for Mental Health Law
(http://www.bazelon.org/)
 Office of Civil Rights: Region 10
 National Alliance for the Mentally ill (NAMI)
(http://www.nami.org)
 National Institute of Mental Health (http://www.nimh.nih.gov/)
Dr. Juno Ju
47
Q&A