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Punching Holes In The Darkness:Punching Holes In The Darkness:Helping Students With Psychiatric Helping Students With Psychiatric

Disabilities Cope Within The Disabilities Cope Within The College CommunityCollege Community

Presenter:Rodney E. Pennamon, M.Ed, CPDM

DirectorGeorgia State University

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Give Us A ChanceGive Us A Chance

We are almost forgotten,You know, the misbegotten,Those who see a different light,A light of darkness bright.

Some say we are insane,Others call us just inane.We can’t help our plight,When our days are one long night.

All we ask, is for a chance,Without let or hindrance,To prove that we can doMost anything just like you.

What we have cannot be caught,Nor is it ever actively sought,Yet society sees us as being rank,Each and everyone a raging crank.

 

 Michael Mann

Yellowknife, N.W.T. January 2000

We seek compassion and understanding, But To have a mind that’s one big knot. So lets all with one accord, And for the final human record, Not hold those with mental malady Responsible to ridicule and parody. Just think about it, you may be next When mind and reality become vexed. Generally it’s misunderstanding, That’s received with a vapid smile, And whispered sniggers full of bile. Why is mental illness so abhorred, When evil often finds its own reward? It depends upon your self-esteem And how you personify it would seem. Bad it might be, but wrong it’s not

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Percentage of Population with Percentage of Population with Disability:Disability:

52.6 million people (19.7%) have some level of disability . 33.0 million people (12.3%) have a severe disability.

High school dropout rate:

22% of students with a disability do not graduate. 9% of students with no disability do not graduate.

College graduation rates:

12% of students with disabilities graduate from college. 23% of students with no disabilities graduate from college.

Source:Us Census BureauCurrent Population Report February 2001 issue

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Adults with Psychiatric Adults with Psychiatric Disabilities on CampusDisabilities on Campus

Mental illness is a widespread and debilitating illness that affects as many as 41 million people in the United States.

Mental or psychological disorders are second only to cardiovascular conditions worldwide in causing disability and premature death. The onset of many major psychological disabilities is in early adulthood, between the ages of 18 to 25, a critical time when young people are leaving home for the first time to attend college and graduate school.

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• There aren’t many good statistics on how many There aren’t many good statistics on how many

people with mental illness attend colleges, apart people with mental illness attend colleges, apart from suicide rates (suicide is commonly linked with from suicide rates (suicide is commonly linked with mental illness) and even then, some critics charge mental illness) and even then, some critics charge that many campuses will not report suicides that that many campuses will not report suicides that occur when students are on leave, or living off occur when students are on leave, or living off campus.campus.

Disability Compliance for Higher Education, February 2001Disability Compliance for Higher Education, February 2001

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Disability Status by SectorDisability Status by Sector

Students with invisible disabilities (chronic health disorders, seizures

psychiatric problems or learning disabilities) make up the single largest disability category among the nation’s undergraduate college students.

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Community colleges enroll the largest percentage of students with disabilities.

More than half of the students with disabilities at two-year and four- year public institutions are male.

Students with disabilities at community colleges are more likely to be older(age 25 and above) than those in other sectors.

Source: Information from HEATH. Vol. 13, No.2, June-July 1994.

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Five Myths About Mental Five Myths About Mental IllnessIllness

Myth # 1 Mental illness is rare on any campus.

Myth # 2 People with mental illness are violent.

Myth # 3 Someone who is mentally ill is just weak and

can “snap out of it” and choose to be better if they want to.

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Myth # 4 Mental illness is incurable.Myth # 5 People with mental illness are not intelligent

and should not be in college.

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What is a Psychiatric What is a Psychiatric Disability?Disability?

A Psychiatric disability (i.e., mental disorder) is a clinically significant behavioral or psychological syndrome or pattern occurring in an individual that reaches a certain frequency, intensity and duration.

It is a disability in one or more important areas of functioning ( psychological, social ,or occupational).

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Psychological Psychiatric Psychological Psychiatric Disabilities Could Include:Disabilities Could Include:

Anxiety Disorders Neurosis Panic Disorder Personality Disorders Specific Phobia Paranoid Social Phobia Schizoid Obsessive-Compulsive Psychosis Acute Stress Disorder SchizophreniaEating Disorders Sleep DisordersEmotional DisordersMood Disorders

Depressive DisordersBipolar Disorders

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Top Ten Problems Top Ten Problems Encountered by StudentsEncountered by Students1. Relationships with family, partners, friends.2. Anxiety3. Academic matters4. Depression5. Bereavement6. Abuse-mental , emotional, physical and sexual7. Intra-personal, including those with low self-

esteem or confidence, as well as the suicidal8. Sexuality9. Transitions, including difficulties adjusting to

university life, or to changes such as parental divorce

10. Drugs, alcohol

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Functional Limitations Due to Functional Limitations Due to Psychiatric DisabilityPsychiatric Disability

1. Screening out environmental stimuli.2. Sustaining concentration.3. Maintaining stamina.4. Handling time pressures and multiple

tasks.5. Interacting with others.6. Responding to negative feedback.7. Responding to change. Source: Psychosocial Rehab. Journal, 14 (2), 3-19

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Recognizing Signs of Mental Recognizing Signs of Mental Illness in the Campus SettingIllness in the Campus Setting

Marked personality change over time. Confused thinking; strange or grandiose ideas. Prolonged severe feeling of depression or apathy. Feeling of extreme highs or low. Heightened anxieties, fears, anger, or suspicion; blaming

others. Social withdrawal, diminished friendliness, increased

self- centeredness. Denial of obvious problems and a strong resistance to

offers of help. Dramatic, persistent changes in eating or sleeping habits. Substance abuse. Thinking or Talking about suicide.

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Signs ContinuedSigns Continued Consistent late arrivals or frequent absences. Low morale. Disorganization in completing school work or in study

habits. Lack of cooperation or a general inability to communicate

with others. Increased accidents. Frequent complaints or evidence of fatigue or unexplained

pains. Problems concentrating, making decisions or remembering

things. Missed deadlines, delays in completing assignments, poor

exam grades. Making excuses for missed deadlines, or poor quality

work. Decreased interest or involvement in class topics or

academics in general. Source: Zuckerman etal. (1993), National Mental Health Association.

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Students with Psychological Students with Psychological Disabilities Possible Conduct Disabilities Possible Conduct

IssuesIssues Classroom disruption Assault of a Faculty member Manipulation and dishonesty Verbally dominates classroom environment Faculty biased against the student with disability Attention getting behavior Obsessive behavior/stalking Alcohol & drug abuse issues

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Possible Special Issues in Possible Special Issues in the Residence Hallsthe Residence Halls

To have a roommate or not? Cleanliness issues Community care taking/burden on the roommate Pressure on RA’s and Hall Directors to be “in

loco parentis” Threat of Suicide Medication issues Parental expectations for the Residence Life staff Student isolation Student disruption alienates the residence hall

floor

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Affect On EducationAffect On Education

Hospitalization usually means the individual is “out” of school for an extended period of time.

Misunderstandings and stereotyping make re-integration difficult.

Student may have a relapse which further reinforces stereotype.

Student must follow the same rule and limits.

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The Role of the Disability The Role of the Disability Support Services StaffSupport Services Staff

In providing services to students with psychiatric disabilities it is important for ODSS staff to separate as clearly as possible, treatment issues from educational issues. Treatment issues, such as therapeutic counseling, medication maintenance,or crisis intervention should be provided by professionals other than the ODSS staff. Campus resources may be available, mental health community resources should be sought.

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Strategies for Working with Strategies for Working with Students with Psychiatric Students with Psychiatric

DisabilitiesDisabilities1. Encourage early disclosure and don’t operate in a crisis

mode.2. Have releases in place so that you can be responsive when

people’s conditions change.3. Clarify with the student his support network(on-campus

support group, therapist).4. Consider offering a support group on your campus.5. Create Liaisons with student affairs or student

development offices.6. Make sure there is a syllabus statement for faculty to use

that addresses disabilities.7. Be aware of options for programmatic accommodations

(i.e. part-time status).Source: Barbara Blacklock, University of Minnesota

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Instructional Program for Instructional Program for Faculty in Dealing with Faculty in Dealing with

Psychiatric Disorders in the Psychiatric Disorders in the ClassroomClassroom

Review the code of conduct. Discuss what constitutes disruptive conduct in

the classroom. Define inappropriate classroom behavior for use

in the faculty member’s syllabus. Give examples of inappropriate classroom

behavior.

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Faculty ContinuedFaculty Continued

Use several case studies of actual problems that have occurred in the classroom.

Explain the student disciplinary process. Describe types of behavior that might be

indicators of psychiatric problems. Describe resources to assist the faculty including

the Dean of Students Office, the Counseling Center, Psychiatric Services, and the Student Health Service.

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Typical Documentation Typical Documentation SourcesSources

PsychiatristClinical PsychologistClinical Mental Health CounselorClinical Social WorkerPsychiatric NursesMarriage, Family, Child Therapists

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DocumentationDocumentation

When documentation for a disability is requested there are several areas which need to be addressed for the college student.1. Documentation of individual’s psychiatric condition

(DSM IV-TR diagnosis with Axis). 2. Dates of registration or treatment (from__to__).3. How the individual’s condition may affect him/ her in the

academic setting.4. Recommendations for academic accommodations.5. Is the students currently in treatment or activity working

with a counselor?

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GuidelinesGuidelines

The following questions can guide service providers in assessing the needs of students with Psychiatric Disabilities.

1. What reasonable accommodations need to be made?2. Is this an educational problem or a treatment problem?3. Do I need to make a referral to a community or campus

resource?4. How would I solve this problem if the person had a

physical disability?5. Has there been a violation of student conduct?6. Am I working harder on this problem than the student

who presented the problem?Source: Roth, Patricia. Virginia Tech. PD Newsletter, Winter 1996.

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Functional DomainsFunctional Domains

Cognitive Behavior Communication Emotion Motor Sensory Perceptual Biological Needs Psychosocial Needs

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Reasonable Accommodations Reasonable Accommodations for Students with Psychiatric for Students with Psychiatric

DisabilitiesDisabilitiesAssistance with registration/financial aidExtended time for examsChange of location for examsPriority parkingNote taking, tape recordersSeating arrangement modificationsBeverages allowed in class ( i.e.,for thirst

resulting from medication)

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Accommodations ContinuedAccommodations ContinuedPeer supportIdentified place to meet on campus that is

non-threatening before or after classIncompletes rather than failures if relapse

occursTraining in time management Training in study skillsSpecial topic courses( college survival,

personal psychology) Early registration

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Accommodations ContinuedAccommodations Continued Incompletes Provide honest feedback when behavior is

inappropriate Orientation to campus Assistance with class selection and class load Allow less than full time involvement in program Referrals to campus and community resources Use the university conduct code when

appropriate

Source: Adults with Psychiatric Disabilities on Campus. (1996) HEATH.

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AccommodationsAccommodationsMyth

My therapist said that I need these things so you must provide them.

Reality Accommodations need to be directly

linked to the underlying disorder Is an accommodations reasonable? Ask:1. Is it necessary in order for the student to enjoy equal

opportunity?2. Is it reasonable in the context of the student’s course of

study?

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DefensesDefenses

Primary defenses available:1. Not otherwise qualified2. Fundamental alteration3. Personal services4. Direct threat

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Helpful ResourcesHelpful Resources The Dismissal of Students with Mental

Disorders by Gary Pavela, J.D.1. Legal Issues2. Policy Considerations 3. Alternative Responses

Coping with the Disruptive College Student:

1. A Practical Model by Gerald Amada, Ph.DSource: The Higher Education Administration SeriesCollege Administration Publications, Inc.

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Envisioning Best Practices for Envisioning Best Practices for Students with Psychiatric Students with Psychiatric

DisabilitiesDisabilitiesHigher Education reaches out to people

with psychiatric disabilitiesSchools provide information on

accessibility for student/consumersHigher education is available to all on the

basis of the ability to learn, not the ability to pay

Students have the right to withdraw from studies because of mental health problems without financial penalty

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Best Practices ContinuedBest Practices Continued

Scholarships exist for students with psychiatric disabilities

Orientation is accessible to student/consumers

Mental health issues are included in orientation events

Access to voluntary early intervention exists for students experiencing their first mental health crisis

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Best Practices ContinuedBest Practices Continued

Staff in all offices of the institution have access to information about services and supports for students/consumers

Residence is accessible for students with psychiatric disabilities

Students with psychiatric disabilities have access to accommodations

Students with psychiatric disabilities are aware of academic accommodations

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Best Practices ContinuedBest Practices ContinuedStudent representatives include the issues

of students with psychiatric disabilitiesVoluntary, free access to a variety of

mental health services, both on-campus and in the community, is available

Support for students experiencing crisis is available

Student status is not conditional upon mandatory withdrawal for students with psychiatric disabilities

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Best Practices: Model Programs Best Practices: Model Programs for Students with Mental Illnessfor Students with Mental IllnessState University of New York at Buffalo http://ub-counseling.buffalo.edu/ccv.htmlUniversity of Michigan www.ssw.umich.edu/sed/about.htmlUniversity of Illinois

www.psych.uic.edu/UICNRTC/project_12.htm.

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Best Models ContinuedBest Models Continued

University of Chicago http://counseling.uchicago.edu/vpc/virtulets.htmlHarvard-Radcliffe http://www.hcs.harvard.edu/~mhaag/York University wysiwyg//78http://www.yorku.ca/cdc/pdp/index.htm

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Case VignettesCase Vignettes

Student A: ADHD/Psychiatric Disorders

Student B: Bipolar Disorder/ Depression

Student C: Schizophrenia/Paranoid Type

Student D: Medication side-effect(s)

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Suggestions for Students Suggestions for Students with Mental Illnesswith Mental Illness

Get an accommodation planTalk with teachersTake a breakAsk for reassuranceGain alliesBe aware of medication side effects

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Suggestions ContinuedSuggestions Continued

Try to let things goMake goalsTry to have some funTry something new in or outside of schoolAsk for exactly what you need

Source: Elizabeth Drucker. (2001), Suite 101.