Areas of Responsibility Risk Assessment Emergency Management Safety and Security Emergency 24/7 First

Responder Management and

Reporting of Individual Student Incidents

Compliance

Physical/Mental Health Health Clearance

Process Student Health

Insurance Students with

Disabilities Student Conduct Title IX/SHO Officer

Take a Moment What are your views about depression, counseling,

mental health, suicide? Recognize your own reactions Where did you first learn about mental health,

counseling, mental illness? How does your family feel about counseling? How does your culture view mental health?

Who is Protected by Section 504 and the ADA?

Persons that • have a physical or mental impairment that substantially

limits one or more major life activities; or o Learning is considered a major life activity

• have a record of such an impairment; or

• are regarded as having such an impairment

National Trends

Depression• Rates among college students have doubled since 1998

Anxiety 200% Sexual Assault 400% Suicidality 300%

(Benton, 2003)

2010 Counseling Center Directors’ Survey

91% report trend continues: greater number with severe psychological problems

70.6% report crisis required immediate response

60.0% report learning disabilities

45.7% report alcohol abuse

45.1% report illicit drug use (Other than alcohol)

http://www.iacsinc.org/NSCCD%202010.pdf

Prevalent diagnoses on college campuses. . .

Anxiety/panic disorders Depression Eating disorders (highest mortality rate) Suicidal tendencies Self injurious behavior Bipolar disorder

College Age (18-25) … Emergence of significant mental illness typically

occurs during college years• Bipolar disorder – increasingly recognized that often the

onset is in adolescence• Schizophrenia – ¾ develop it between 16 &25; onset

uncommon after 30• Major Depression• Personality Disorders

Adding Complexity Non-disclosure due to stigma and fear

• fear of being labeled, judged, and perceived differently Sleep deprivation (high cost)

• irritability, moodiness, psychopathologies (depression, ADHD, etc.), decreased concentration and memory

Stress Developmental stages (counseling concerns)

• On campus psychological emergencies overtax delivery of services to general wellbeing and developmental needs of the student population

Adding complexity High risk behaviors: Substance abuse

• Co-occurring mental disorders are common where substance abuse is present

Buying/selling medication; abuse of non-prescribed medication; abuse of OTC medication (cough and cold medicines, etc.)• Adderall

Self-medicating - non-prescribed

Non-compliance with medication; significant issue• Side effects• Interferes with alcohol consumption

Adding complexity Student’s failure to obtain needed help

• Resistance • Lack of awareness• Stigma; discrimination

Therapy reluctance• Waiting until problems are severe • Reluctance to continue treatment (time commitment)• Family cultural values; parental denial

Alcohol Abuse Binge drinking: five consecutive alcoholic drinks for

a man, four for a woman• 2 of every 5 students—more than 40 percent—

About 1,825 college students die each year in alcohol-related accidents – unintentional injuries, including automobile accidents

About 97,000 students are raped or sexually assaulted each year

http://www.niaaa.nih.gov/Pages/default.aspx

Alcohol Abuse About 696,000 a year are assaulted by another

student who has been drinking About 25% say alcohol has hurt their academic

performance 8% – 400,000 students – report having unprotected

sex when drinking (increased risk for pregnancy, AIDS, STDs)

100,000 too intoxicated to know if they consented to having sex

Are Current Users of Alcohol Excluded from Protection under Section 504?

No. Section 504's definition of a student with a disability does not exclude users of alcohol

However, Section 504 allows disciplinary action against students with disabilities using drugs or alcohol to the same extent as students without disabilities

Next Exit? Study Abroad

studentsSupporting

Consultation

Consultation is key Do not try to handle things on your own Know your institutional counseling staff

■Culture Shock A normal developmental phase of adjustment Mimics more severe psychological problems such as

clinical depression and anxiety …o feeling helpless, out of control, vulnerable, fearful, anxious,

confused, crying or sleeplessness

■Usually Time Limited – (e.g. 2-weeks)

Contributing elements

Separation Travel stress Culture shock; different

expectations Adjusting to local conditions;

social pressures – new friends Learning or using a learned

foreign language to communicate

Managing condition in unfamiliar setting; foreign language skill

Preexisting or dormant conditions

Change in medication Stopping medication Lack of continuity of care─no

plan Self medication (drugs,

alcohol, etc.) Unforeseen events New relationships gone wrong Financial hardship

• Financial hardship of family in the U.S. due to job loss

Impact on Education Abroad Upward trend in the number of students with mental

disorders (mild – severe)

Local laws are different

Culture is different

Local language may be different

Common Issues Abroad Substance Abuse Anger Management Disregard of others within

student community Abruptly stopping

medication, or medication not legal/locally available• “magic cure”

History of eating disorder Unable to manage health

condition

History of severe depression, anxiety, bipolar disorder

History of suicide attempt/ideation• Suicide is the second

leading cause of death in college students; the third leading cause of death in adolescents.

Students without any psychological illness experiencing symptoms for the first time abroad

Cutting

Best Practices

UCEAP Policy

Provide assistance with reasonable accommodations to qualified students with disabilities to help their successful participation in the University's educational programs and activities

Encourage disclosure after acceptance to assess accommodations in host country

Require pre-departure health clearance

UCEAP Team Approach Abroad

StudentUCEAPUCEAP

Partner InstitutionPartner Institution

Student Health CenterStudent Health Center

Alcohol/Drug ProgramAlcohol/Drug Program

Disability Services OfficeDisability Services Office

Counseling CenterCounseling CenterLocal ResourcesLocal Resources

Medical Assistance ProviderMedical Assistance Provider

Mobility InternationalMobility International

Best Practices Close work with University Counsel and Risk

Manager (protocols, forms/contracts) Design policies to allow withdrawal for medical

reasons (involuntary withdrawal?) • Consider: Work with travel assistance provider, can

student travel alone? • Treatment resources for a safe transition back to the U.S.

campus Design policies to allow return to program; know if

you can stipulate conditions

Best Practices

Clearly delineated protocols

• Before departure/during program

• Review and update protocols and policies regularly

• Legal implications should never be the main concern—student/faculty/staff safety

Best Practices Require health insurance; med evac/repat

• Know your insurance/assistance providers

Require a pre-departure health clearance• After acceptance• Explain confidentiality• Encourage self-disclosure• Consider pre-departure safety health plans

Best Practices Learn about health resources and have a list

ready before you need a referral • U.S. Embassy• Insurance carrier (travel assistance)• U.S. programs in area• U.S. university counseling center• Local health clinics and hospitals• Local health practitioners and specialists (English

speakers; culturally sensitive)

Best Practices

Be aware of the attitudes toward mental disabilities in the local culture; explain to students

Determine the role of culture in diagnosis, treatment and outcome of mental illness

Training

Why is Training Important?

Some students in distress seek help Others will not seek help, but will show warning

signs Impact is on ALL students in program

Understand your Role: 5 Simple Steps

1. Learn to spot signs of distress early(Assess student behavior: Is it normal? Atypical? Any warning signs?)

2. Know how to offer support; work with student3. Connect student to resources; know your limits4. Know emergency procedures; insurance coverage;

assistance provider5. Do not offer support beyond your expertise and

official duties

Why are Training and Collaboration Important?

Cross-train Counseling and Student Health staff• Consultants• Prevent stigma• Privacy vs safety• Guidance about local resources/legality of prescribed

medications from EAO• Helps to remain focused and calm• Helps with international students on your campus and

study abroad students (natural disaster, major unrest affecting the host country)

Pre-departure:• Discuss with student anticipated challenges, management

plan and risks• Identify treatment provider in host country before leaving

home• Consider agreeing to a Safety Health Plan (spelling out

expected behaviors and consequences of not following)• Send message to all students about local resources,

medication

Do’s. . . Be realistic about local

resources Have contingency plans in

place Provide pre-departure

information for students and parents

Normalize process to ask for help

Express your concern directly

Have a plan, especially if clinical support is needed when abroad

Offer assistance with appointment (use your assistance provider)

Remove barriers (lack of money

Use a team approach

Don’ts. . . Diagnose or analyze

(not your job) Minimize problems Ignore comments about

suicide Be sworn to secrecy

Try to manage situation by yourself

Forget to self care (seek support for yourself)

Be caught without a plan

The majority of students with disabilities can participate successfully • Proper planning• Discuss potential study abroad stressors• Provide resources

You can help…

Resources Active Minds (peer to peer resource)

• http://www.activemindsoncampus.org/

The American Association of Suicidology• www.suicidology.org/

American College Health Association• www.acha.org/

American Foundation for Suicide Prevention• www.afsp.org

Resources Bazelon Center for Mental Health Law

• www.bazelon.org/

College Drinking – Changing the Culture• http://www.collegedrinkingprevention.gov/

Jed Foundation• www.jedfoundation.org

Resources

NAFSA Best Practices in Addressing Mental Health Issues Affecting Education Abroad Participants• www.nafsa.org/mentalhealth

My Student Body• www.mystudentbody.com

National Institute on Drug Abuse• www.nida.nih.gov/

Resources

Substance Abuse & Mental Health Services Administration • www.samhsa.gov• What a Difference a Friend Makes

o http://whatadifference.org/support.asp?nav=nav02_3&content=2_3_3_peers

Helping your Student when Stress Turns into Distress (Guide for Parents)http://uhs.berkeley.edu/parents/stress.shtml

Resources The Loneliest Disease

• http://www.wtop.com/?nid=226&sid=1357907 • WTOP's Darci Marchese and Kate Ryan look at the impact of mental

illness

Urban Dictionary• www.urbandictionary.com

World Health Organization• Mental Health Atlas

o http://www.who.int/globalatlas/default.asp

University of California, Berkeley Online Staff Training http://uhs.berkeley.edu/facstaff/CPStraining/index.htm

http://uhs.berkeley.edu/training/violenceawareness/

Contact information:

Inés DeRomaña, Principal AnalystHealth, Security, and Emergency ResponseUniversity of California SystemEducation Abroad Program6950 Hollister Ave. Suite 200Goleta, California 93117-5823U.S.A.Ph: 1+805.893.7936|Cell: 1+805.451.1704 |Email: ideromana@eap.ucop.edu

Permission to Use Conditioned on acknowledgement of Ines DeRomana

as the author, with copyright belonging to The Regents of the University of California.