Responding to the Changing Landscape of College Mental Health with Comprehensive Crisis Intervention and Health Promotion Strategies

June 10, 2009Cory Wallack, Ph.D.

Today’s GoalsReview the changing landscape of college

mental health and the impact on provision of crisis intervention services

Explore both philosophical and practical concerns as they relate to effective crisis intervention services

Discuss readiness issues and questions that should be addressed before implementing crisis intervention strategies, programs, and protocols

Present an overview of Syracuse University’s comprehensive crisis intervention and health promotion model

A Brief Case Discussion to Get Us

Started

At intake a client reports:Frequently feeling overwhelmed because of multiple

tasks, responsibilities, and demands to balanceDifficulty prioritizing tasks, difficulty multi-tasking,

difficulty balancing various responsibilitiesBarely keeping her head above water, always on the

runHigh performance expectations

Failure is not an optionExternal and internal expectations of being able to

do it allSense that multiple others are watching and

waiting to see if she fails or succeedsAlthough feeling pressured and overwhelmed, she is

fearful and/or unable to voice concerns to others for fear of how she may be perceived or judged

A Few Questions and Reflections to Keep Us Going

Back to Our Case Discussion:Life in a Counseling Center

Fast paced, high demand, high stress workIncreasing intensity of client presenting

problems coupled with increasing numbers of students seeking our services

On-going struggle with balancing individual clients, crisis response, group clients, outreach/education, paperwork, etc.

Burnout level is high, feeling stressed and overwhelmed is common

To know where we are going, we have to know how we got here…

The Changing Landscape of College Mental Health

High profile legal and media casesMIT, Ferrum College, George Washington, NYU

Increased emphasis on studies reporting high rates of hopelessness, depression, suicidal ideation

2005 National College Health Assessment 2006 Counseling Center Consortium Data Counseling Center Directors' reports

Garrett Lee Smith Act and JED FoundationVirginia Tech and Northern Illinois

The Changing Landscape of SU’s Counseling Center Services

2007 Statistics

4546 Client Contacts1523 Students

Receiving Services304 Emergency Assessments 216 Psychiatry

Clients18.2% of clients

report suicidal thoughts

2008 Statistics

4871 Client Contacts

1579 Students Receiving Services

440 Emergency Assessments

234 Psychiatry

Clients 23.6% of clients

report suicidal thoughts

Percent Change

7%3.7%

45%

8.3%5.4%

The Changing Mental Health Picture of Our Students

Students coming to campus with more significant mental health problems

Students described as:Facing overwhelming demandLacking coping skillsLacking distress tolerance

Connected-disconnected generationImpact of global eventsSoaring tuition ratesHelicopter parents

Responding to the Changing Landscape

Counseling Centers at maximum client capacity and lacking resources to meet the demand, yet students expecting to be seen immediately – e.g., increased crisis intervention

Increased demand on colleges and universities to demonstrate comprehensive crisis intervention, risk assessment, and suicide prevention programs

Increased employment of mandated assessments, mandated counseling, and forced leave of absences

Increased employment of behavioral consultation teams and case managers

Taking a Step Back:

What Exactly Is Crisis Intervention?

Crisis Intervention Broadly Defined

Primary Prevention and Mental Health PromotionCoping skills, stress management, distress tolerance,

relationship skills Stopping the crises before it starts

Secondary & Tertiary Intervention Identifying and intervening with distressed students

Postvention and follow-upPolicies and Procedures

Mandated assessments, leave of absence, etcIdeally, your campus should address all of the

above

Where to Begin?SPRC/JED Comprehensive Model

Where to Begin?The Importance of Sound Data

Know the national and local data on student mental healthGenerally speaking, campuses are safe placesA caution about how we reinforce the culture

of fearWhat is the unique nature of your campus

climate regarding mental health?Consider a needs assessment

Survey students and parentsSurvey faculty and staff

Where to Begin:Assessing Your Campus CultureSome questions to consider:

To what extent does fear impact your system?To what extent does the language of liability drive

decision making?What is the system’s level of distress tolerance?Are decisions being made rationally?Does your system tend to be reactionary or proactive?Does the system have a balance of prevention and

“intervention”Does your system recognize its limits, resources, etc and

create an appropriate model for your students, or is there a parallel process at play?

To effectively move forward, we have to thoroughly understand the culture we are working in and address it first

Philosophical Thoughts on the Role of Counseling Centers

College counseling centers can and should be the leaders in developing mental health protocols, policies, procedures, programsAt times, mental health professionals appear to

have lost their voiceToo often we defer to attorneys and

administrators who may not be expert in the field of mental health

The vast majority of counseling center staff aren’t qualified to conduct threat assessment

Counseling center staff can’t do it alonePublic health model is a vital approach

Where to Begin?The Importance of Theory

What are your driving beliefs, theories, and passions about crisis response?JoinerBaumeister“Well Theory”“Dark Nights of the Soul”

Essentially a mission, vision, and values statementSound theory allows you to connect all crisis

intervention protocols back to central driving themes and values

So You Have a Theory and Know The Culture: Now What?

The Example of Gatekeeper Training

Readiness Issues:Preparing the system

Gaining institutional support for the trainingAre relevant parties aware of the training?Will they be trained as well?Think top-down and bottom-up

Review relevant policies/procedures/protocols for the various departments you will be working withMandated assessments

Does your campus have a plan for after hours emergenciesRemember, our students live in a different time

zone than most of us!

Readiness Issues:Counseling Center Concerns

Is the counseling center staff trained and prepared to effectively respond to students in crisis?Crisis intervention is a specific skill setThreat assessment and suicide assessment

Is the counseling center staff prepared for consultation role?

Is there sufficient availability of emergency appointments and walk-in assessment?

Do you have sufficient availability of psychiatric services

If you don’t have sufficient resources to address the above, do you have referral resources in place?

Readiness Issues:Assessing Your Resources

Driving question: How can you most effectively and efficiently utilize existing resources?

TimeHow much do you have? How much do you ideally

need?People

Who are your gatekeepers?Who are your trainers?What involvement do you want faculty to have?What is the role of students?

MoneyCan you secure grants or partner with other offices to

enhance cost efficiency?

Readiness Issues:Marketing Your Efforts

How can you market the trainingPress releasesSchool newspaperMailingsSuicide prevention “Kick-off” event

Handouts to give participantsReference cardsCertificate of completion

Readiness Issues:Evaluating Your Program

What goals are you trying to achieve?Need to be realisticNeed a timelineNeed to be measurable

How to measure training “success”Increased referrals

Base-line data is ESSENTIALIncreased knowledge and skills

What tools are there available to use?

Other Elements of a Comprehensive Crisis Intervention and Health

Promotion Model

Primary PreventionStudents

Stress managementRelationship building skillsCommunication skillsConflict Resolution

ParentsTrainings frequently target identifying warning

signsWe have an opportunity to help parents better

support studentsHelicopter parents will attend workshops if

invited!

Secondary and Tertiary PreventionIndividually targeted efforts:

Behavioral consultation committeesTriage issuesCase managers

Broader targeted effortsDepression/Anxiety screening daysOn-line screeningsGatekeeper training

Postvention and Follow-upFactors to consider following student death

Do you have a formal crises response team?Do you have structured processes for

conducting debriefings?Are staff that conduct debriefings properly

trained?Do you have pre-established relationship with

appropriate media outlets?How is information communicated across

campus?What happens days, weeks, months after the

event?

A Comprehensive Campus Prevention Model

An Example From Syracuse University

Defining Our Philosophy and Strategy

Our beliefs, guiding theories, and passionImpact of loneliness, isolation, lack of coping

skillsContributions of Joiner and Baumeister

Answering these questions lead to a strategy….ConnectionDistress toleranceAcceptance

Comprehensive Crisis Intervention InitiativesMH awareness and

services utilization survey

M.H. policies/procedures which sensitively respond to high risk behaviors (e.g. MLOA, mandated evaluations)

Enhanced clinical services—increased emergency and psychiatric services; AMSR training for CC staff

Gatekeeper training for students, staff, & faculty-Campus Connect, Distressed Student Module

Life Skills Development—MBSR program

Facilitating Help-seeking behaviors--campus wide media campaign/

Sustainability Plan

Creation of Our Broad GoalsFoster a greater sense of individual and

community connection

Positively influence campus culture by creating a greater tolerance for and acceptance of emotional distress

Promote life enhancing skills

Destigmatize mental health problems and increase help-seeking behaviors

Creation of Specific and Measurable GoalsCampus Connect

Train ORL, Health Services, Academic Counselors

Measure increased knowledge, skill, efficacyMBSR

Train students life skillsMeasure perceived stress, physical symptoms,

coping skillsCounseling Center awareness and utilization

Pre and Post initiative assessments

We Had a Strategy and Goals...But, How to Resource It?

Perfect timing for securing the SAMHSA Suicide Prevention GrantStayed true to our philosophyComprehensive and preventativeAllowed for innovation and creativity

Grant allowed us to fill in the gaps and create a unique, philosophically connected program

Post-grant considered sustainability

The Program Has Been A Success…But, How Do We Sustain it?

Know, educate and involve key University playersGive them languageBring them “into” your broad visionWhat’s in it for them?

Communicate your program’s data resultsTailor your data to each different audience

Write a good “white paper”Outline the strategic plan succinctly and realistically go

for the “ask”University Institutionalization

Increased resourcesCross campus mental health task force

New Pieces To be AddedBehavioral consultation committeeParent/Family workshopsMore direct outreach and support for

students through Office of Multicultural Affairs and International Student Services

Integrated eating disorder treatment protocols

Community liaison working more directly with community agencies

Questions and Comments