Campus Wellbeing and Support Services

Responding to mental

illness in a tertiary setting

Dr Carmen Germain

Clinical Psychologist MAPS

Student Care and Trauma Lead

Dr Benjamin L Wilkes

Clinical Psychologist MAPS FCCLP

Manager, Allied Health

How many people are affected?

Recent surveys found 1 in 5 Australian adults will suffer from some form of common mental

disorder in any year.

> So for every 5 people in this room, 1 may experience a mental health problem in 2017

18 – 24 yr olds have the highest prevalence of any age group – 1 in every 4 people.

> For every 4 students in this age group on campus, 1 may experience a mental health

problem this year

First onset of psychosis often occurs in late teens and early twenties.

> Psychosis affects around 5 people in every 1000 people, every year

Common issues

The following issues are the most common ones that affect students who seek

counselling and psychological support from Campus Wellbeing:

• Anxiety / stress

• Depression / low mood

• Family / relationships

• Adjustment struggles

• Grief and/or loss

We also see students experiencing psychosis and autism spectrum diagnoses regularly,

but not frequently.

Study related difficulties: progression, procrastination, presentations / participation,

student : student conflict (e.g. group work), supervisor: supervisee conflict.

How can I identify mental health problems?

A mental disorder causes significant change(s) in a person’s thinking,

emotional state and behavior across many different situations.

It significantly disrupts the person’s ability to work/study and their

personal relationships.

Causes and triggers?

Some of the common causes and triggers that we see on campus include:

• Genetic predisposition / vulnerability (family members also experience mental

health problems)

• Stress from the environment e.g. work load, adjustment to living/studying in

Australia, problems with study progression, relationship breakdown, financial

hardship, organizational change, difficulties finding stable accommodation

• Drug and alcohol use

Signs to look for - Anxiety

Panic attacks: Rapid, shallow breathing

Looks fearful/afraid

Reports feeling dizzy

Rapid and/or jumbled speech

Appears agitated (difficulty sitting still, jiggling around or very stiff)

Trembling/shaking

Appears distressed (tearful)

Sweating (although it is not hot and they have not been exercising)

Difficulty concentrating or focusing

Appears to listen but difficulty taking in what you are saying

Feels sick (nausea)

Signs to look out for - Depression

Appears “flat” in facial expression, tone of voice and mood

> This means that there is little emotion as they interact with you;

facial expressions and voice don’t change much

Negative thinking about themselves and the future

Reporting thoughts of suicide/self-harm

Reporting actual attempts to suicide/self-harm

Tearfulness

Slowed speech

Slowed/sluggish walking/movement

Poor grooming (body odour, unwashed hair or clothes)

Signs to look for - Psychosis

Most frequently reported to CWB is odd ideas or odd behaviour

> e.g. telling others that they believe they are being watched,

or that people are talking about them behind their back

Other signs can be:

Confused or irrational language

Incoherent or jumbled speech

Seeing things or hearing things that aren't there

Difficulties concentrating, paying attention

May be responding to voices (e.g. appear to be talking to themselves)

May appear distressed, agitated or disheveled

Inappropriate clothing or grooming

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The Difference between mental disorder

(anxiety) and stress

Both are negative emotional experiences that can make you feel exhausted and edgy, steal your focus, cause you to lose time and not complete tasks.

Stress is caused by an existing stress-causing factor or stressor (temporary).

Anxiety is stress that continues after that stressor is gone (sustained). People are less aware of what they’re anxious and worried about in the moment.

Stress can come from any situation or thought that makes you feel frustrated, angry, nervous, or even anxious.

Why do WE experience difficulty?

When threatened, brain activates threat response

(This is generated before our conscious mind can work)

Reduces capacity for logical thought

Generates fight/flight/freeze

reactions

Characteristics of Distress

Only see their own point of view

Cannot reason logically

Personalise rather than focus on the issues

See the problem not the solution

Find it hard to remember the details

Do not hear other perspectives

May make quick decisions without thinking

What Distressed People May

Want or Need

Acknowledgment

Respect

To be listened to and heard

To be taken seriously

To get immediate action

To gain certainty/control/clarity

Options/choices

Specific Strategies: Anger

Remind yourself it is not personal

Lower the volume of your voice as they raise theirs

Listen for themes/needs

Ask if they would like to speak to your manager

Avoid defending a decision – broken record

Provide a range of options if possible

If extreme, remove yourself from

harm’s way and call for support

Report as appropriate

Specific Strategies: Anxiety

Be aware that anxiety primes us to filter out

the positive

Emphasise what they can do

Write options down together, or give them

written brochure-type information

Let this person know that they can talk to

you about it openly, without any fear of

judgment.

Don’t pressure them to "just relax" or "calm

down"

Specific Strategies: Sadness or

Numbing

Ask to re-state what is happening and what it means

Empathise and acknowledge: “this must be tough for you”

Count to 10 in your mind after you ask a question

May reduce eye contact if tearful:

“I can see that you are getting upset. That’s not my

intention”

If they are not talking - “what is going on for you right now?”

Help them identify what they can manage at this point in

time

What tells me that someone is distressed?

Academic signs

Excessive absences or loss of motivation

Consistent failure to turn in work or complete tasks to deadlines

Marked changes in concentration

Neglect of personal responsibilities

Noticeable decline in quality of work or writing and class participation

Poor performance and preparation

Repeated requests for special consideration/subject withdrawal

Avoiding participation / failed absents

Excessively anxious when called upon

What tells me that someone is distressed?

Behavioural

Increased procrastination and avoidance of tasks

Withdrawing from friends and family

Poor self-care and neglected personal hygiene

Being excessively demanding of others

Increase in impulsive behaviour

Self harm

Increase in alcohol or drug misuse

Talk of suicide (e.g., "I won’t be around to take that exam anyway." or "I’m not worried about getting a job,

I won’t need one.")

Violent acts towards self and/or others

Extreme dependency on faculty or staff, including spending much time visiting during office hours or other

times

Keys to responding

26OFFICE I FACULTY I DEPARTMENT

MHFA MODEL

Assess risk of suicide or harm

Listen non-judgementally

Give reassurance and information

Encourage the person to get appropriate professional help

Encourage self-help strategies

R U OK MODEL

1. Are you okay?

2. Listen without judgement

3. Encourage action

4. Check-in

Do

• If possible, choose a time and place that affords privacy and limited interruptions for your

conversation

• Try to listen attentively and patiently – it may be difficult for the student to find the right

words to explain their situation; sit with the silence and try to focus on what has been said

versus how it has been said

• Try to speak respectfully and take the student’s feelings seriously (“I can see that it is very

upsetting for you”)

• Ask what help they would prefer and support the student’s agency (“Would you like me to

call someone for you?” rather than “I’ll call the Counselling Service now and book you in”)

• Suggest options, encourage them to seek appropriate support – gently (“It sounds like it

might be helpful for you to talk with someone about this; what do you think?”, rather than

“You need to see a psychiatrist or counsellor”)

Don’t

• Promise in advance to keep the information secret as you will need to breach

confidentiality if you believe the student or someone else is at risk of harm

• Analyse the student’s motives (“you only feel that way because…”; ‘Why are you coming

to me with this just as the assignment is due?’)

• Argue, lecture, ridicule or minimise their experiences (“you wouldn’t be in this position if

you had…”; “I think you’re over-reacting”)

• Ask questions that might imply judgement or blame – (“Have you done anything about

this yet?”, “Why didn’t you tell someone before now?”)

• Share your own experiences of being highly anxious or overwhelmed, or your own

experiences of assault/abuse/trauma/grief/loss

• Attempt to physically console or comfort a student by hugging them or holding their hand

When to seek advice

In order to assist a student who may be experiencing mental health difficulties it is wise to

consult with colleagues or Campus Wellbeing (mental health professionals) / Security, IF:

• The situation is unclear or you don’t know the student well enough to assess their

behaviour

• You do not know what to do or what options are available to the student

• You want to talk through how you are managing a situation

• You believe the student is at immediate risk

• You believe there is an imminent risk of harm to others

• You feel overwhelmed or out of your depth

• You feel sad or cannot stop thinking about the personal circumstances of the student

• You think you would find it helpful to do so.

Why someone may communicate self

harm or suicidality

• Being very emotionally upset by their situation/circumstances

• Feeling at their “wits end”

• An attempt to end unmanageable pain

• An attempt to gain a particular outcome

• Related to a mental illness

• Catastrophising a common experience/shame and guilt

Risk Factors Vs Warning Signs

Heart Attack SuicideRisk Factors – indicate that someone is at higher risk

•Tobacco use•Obesity•High LDL cholesterol•Physical inactivity

•Prior suicide attempt•Mood disorder•Substance Misuse•Access to lethal means

Protective Factors – indicate that someone is at lower risk

•Exercise•Healthy diet•High HDL cholesterol•Stress Management

•Strong social connections•Available physical and mental health care•Coping skills

Warning Signs – indicate that someone is having a heart attack or is seriously considering suicide

•Chest pain•Shortness of breath•Cold sweats•Nausea•light-headedness

•Threatening to hurt self•Seeking means to end life•Hopelessness•Increased substance use•Dramatic mood changes

What to do if you are concerned about a

student or staff?

Concerning behaviour (aggression, threats of harm to self or others)

Let your supervisor know

Report the incident to the Risk and Hazard team at Human Resources via concerning or

threatening behaviours online if you don’t require immediate support. Once reported, your health

and safety advisor and other key resources will be drawn upon to address the matter raised.

The report about a student will be shared with Campus Wellbeing for follow-up.

Remember, you do not have to keep this information confidential as you are not a health

practitioner. You have a WH&S obligation to report concerns.

Supports for students

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During business hours:

Immediate risk evident: use standard processes for dealing with emergencies

No immediate risk evident:

Campus Wellbeing: You can phone Reception and discuss the situation and

how to respond.

Phone Ext 7497

Email campuswellbeing@mq.edu.au

Macquarie University CareMQ

1800 2273 67 (24 hour service focussed on providing advice regarding the

immediate management of health and wellbeing issues).

Supports for staff

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Immediate risk evident: use standard processes for emergency situations.

No immediate risk evident, you can refer staff to:

Employee Assistance program 24 hours, 7 days/week

Phone: 1300 360 364

E-counselling (available online: https://www.eapdirect.com/)

Your GP or the University Medical Service – Phone: 9812 3944

Mental Health Line 1800 011 511 for referral to out-of-hours mental health

services

Look after yourself

Debrief – with colleagues, family/friends, supervisor.

Take time out – go for a walk, sit in tea room or spare office for a while.

Stress-relieving activities (e.g. physical exercise, listening to music)

Avoid use of alcohol or stimulants (e.g. caffeine).

Try to keep normal routines going at work and home.

CareWISE Wellbeing Information and Support for Employees (iLearn)