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Counselors As Mental Health Consultants
Sharon Mitchell, Jessalyn Klein, & Brad Linn
University at BuffaloCounseling Services
Introductions
• Introduce presenters & context
Learning Objectives
• Understand types of mental health consultation taking place on a college campus
• Name most common concerns consultees bring to counseling centers
• Obtain recommendations for more effective consultations
Roles and Function of College Counseling Centers
• Counseling (individual, group, couples, family)
• Prevention & education• Training• Mental Health Consultation (growing
role)
Mental Health Consultation Assumptions
Consultation is: • a problem solving & educational process• dyadic or triadic• voluntary• collaborative• temporary• focused on mental health problems
Adapted from Michael Dougherty (2009)
Assumptions cont’d.Consultation:• helps both Consultee & Person of Concern
(POC)• is a relationship in which Consultant has no
control over Consultee’s actions• is a situation where Consultant may/may
not have direct contact with POC• entails working with Consultee to enhance
Consultee’s effectiveness in assisting POC
Venues for Consultation on a College Campus
• After hours On-Call Crisis Intervention
• Students of Concern (SOC)/Behavioral Intervention/Threat Assessment Team
• External Consultations: Phone, e-mail, or face-to-face contact with concerned others (family, friends, faculty, staff)
How Was On-Call Service Used?
• Total number of calls: 58• Total number of consultees: 41 people*• Average call length: 28 minutes, range
8-125 minutes• Most consultees were students seeking
assistance for him/herself (76%)• 24% were others consulting about a
student
Typical On-Call Consultee
Typical POC was a Caucasian, heterosexual, undergraduate (male
or female) who reported high level of general distress and was already a
client at the counseling center
On-Call POC: Demographics
(n =41)
Gender
%
Male 51%
Female 49%
Academic Status
%
Undergraduate
67%
Graduate 25%
Race/Ethnicity
%
Caucasian 68%
Asian 15%
Black 5%
Hispanic 5%
Other 3%
Sexual Orientatio
n
%
Heterosexual
71%
LGBTQ 17%
Unknown 12%
International Students = 19%
85% were current clients
Age
Mean = 23.2
Range = 18-39
On-Call Consultees: Description
Self
(cal
ler)
Frie
nd/P
artn
er
Stud
ent A
ffairs
No UB
Affilia
tion
UB St
uden
t
Fam
ily0%
10%20%30%40%50%60%70%80%90%
100%
On-Call Consultations: Reasons
Suicidal th
ough
ts
High
gene
ral d
istre
ss
Anxiet
y/Pa
nic
Depre
ssive
sym
ptom
s
Relat
iona
l pro
blem
s
Med
ical/M
edicat
ion
issue
Trau
ma/
Loss
Psyc
hotic
sym
ptom
s
Conce
rn fo
r som
eone
Acad
emic d
istre
ss0%
10%
20%
30%
40%
50%
On-Call: Interventions• Coaching (95%)
• Contracting for safety• Short-term coping skills or problem-solving• How to talk to someone you are concerned about
• Referred to Counseling Services (93%)• Sent for hospital evaluation (7%)• Referred to community services (2%)• Other points of contact
• 27% Students of Concern• 44% External Consultations
On-Call: Case Examples
• “My father is annoying me by calling all the time”
• “Holding on to distress all weekend”
Students of Concern Committee
• Representatives: University Police, Judicial Affairs, Residence Life, Health Services, Counseling Services, others as needed
• Meets weekly• Hospital transports for alcohol or
mental health• Role of Counseling Services Rep
SOC Referral Source, Contact & Transports (n = 136)
Discussed at SOC %
Discussed once 55%
Discussed > once 44%
> 1 distinct incident 7%
Referral Source
%
Campus Police 44%
Faculty/Staff 42%
Student 5%
Family 4%
Student Affairs 4%
No affiliation 2%
Alcohol or Mental Health Hospital Transport
20%
Typical Student of Concern
The typical SOC is a Caucasian, undergraduate, male who is not a client at the counseling center. He was referred to the committee by
campus police or faculty/staff because of concern about his suicidal thoughts or behavior.
Students of Concern: Demographics
Age
Minimum = 18
Maximum = 29
Mean = 23.2
Race/Ethnicity
%
Caucasian 54%
Asian 27%
Black 12%
Other 5%
Hispanic 2%
International Students = 19%
Gender %
Male 57%
Female 43%
Client Status %
Non-client 60%
Current client 27%
Former client 13%
Reason for SOC Referral:
Suicidal id
eatio
n
Vict
im o
f crim
e
Psyc
hotic
sym
ptom
s
Disrup
tive
beha
vior
Perp
etra
tor o
f crim
e
Conce
rn fo
r som
eone
Med
ical/M
edicat
ion
issue
Perp
etra
tor o
f har
assm
ent
Additio
n/Su
bsta
nce
use
0%
10%
20%
30%
40%
50%
Students of Concern: Interventions*
• Student support coordinator 66%• Counselor notified 38%• Referred to counseling 17%• Judicial hearing 14%• Police follow-up 13%• Counseling Services outreach 8%• Mandated evaluation 6%• Referred off-campus 3%• Referred to Health Services 2%
Students of Concern: Case Example
“Victim of Home Invasion“
“Significant Disruption in the Apartments”
External Consultations: Overview
• Emails, calls, or in-person consultations with counseling staff during business hours
• 283 unique cases; 553 total consultations
• 36% had multiple consultations• Only 1 student consulted about
him/herself• 24% were discussed at SOC meeting• 5% had at least one On-Call Contact
External Consultation: Demographics
Gender %
Female 56%
Male 46%
Transgender
1%Age
Minimum = 17
Maximum = 49
Mean = 23.4
Race/Ethnicity
%
Caucasian 63%
Asian 19%
Black 7%
Unknown 6%
Hispanic 2%
Multiracial 2%
Academic Status
%
Undergraduate 68%
Graduate 27%
Non-matriculating
5%Client Status %
Non-client 29%
Current client 54%
Previous client 17%International Students =
18%
External Consultees: Description
Facu
lty/S
taff
Off-Cam
pus pr
ovider
Fam
ily m
embe
r
Campu
s Po
lice
Stud
ent A
ffairs
No UB
affilia
tion
Health
Ser
vice
s staff
Stud
ent*
0%10%20%30%40%50%60%70%80%90%
100%
External Consultations: Reasons
Off-ca
mpu
s tre
atm
ent
Poss
ible suicida
l stu
dent
Acad
emic d
ept.
lette
rs
Med
ical/M
edicat
ion
issue
Disrup
tive
beha
vior
Acad
emic p
roblem
s0%
10%
20%
30%
40%
50%
External Consultations: Interventions
• Referred to Counseling Services70%
• Coaching 24%
• Related to hospital evaluation10%
• Referred off campus 9%• Police assistance requested
4%
External Consultations: Case Examples
• “She was behaving very erratically”
• “My son has a history of anxiety and depression”
A Special Case: No-Name Consultations
• Note used when POC was not a student OR when student name was not shared
• 59 No-Name notes for 55 people
No-Name Consultations: Demographics
Gender %
Female 47%
Male 40%
Unknown
13%
Consultee Status %
No UB Affiliation 43%
Faculty/Staff 20%
Family 15%
Student 7%
Non-UB Friends/Partners
2%
POC Status %
No UB Affiliation 47%
UB Student 42%
UB Faculty/Staff 7%
POC: Description
%
Another Person 75%
Self 24%
No-Name Consultations: Reasons
Addictions/Substance
Use
Eating Disorders
Relational Problem
Unknown Need UB Info
Learning Disability
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
No-Name Consultations: Interventions
• 62% of consultees referred to off-campus providers
• 18% of SOCs referred to Counseling Services
• Only 9% of consultees were coached
Summary Thoughts on Data
• The following varied based on type of consultation:• POC status• Consultee status• Problem type• Intervention implemented
• Consultation is:• time-consuming
• Total of 916 consultation contacts• Requires case management tasks• Requires thorough documentation• Augments AND takes time from direct clinical services
• A pathway to counseling• An Environmental Management Approach
Recommendations for Effective Consultations: Consultees
• Provide a student name & ID# or D.O.B
• Be willing to be a part of the solution & the plan
• Seek to understand limitations of the consultation
Recommendations for Effective Consultations: Consultants
• Benefits/necessity of having student names
• Ask for a call-back number or e-mail• Follow up with an e-mail• Be firm, direct, & honest. • Discuss why confidentiality is not always
possible• Do risk assessment• Validate consultee’s feelings & fears
Recommendations for Consultants Cont’d
• Assume the role of coach • Be “the Calm in the Storm” – debrief
later• Provide developmental context• Discuss limit setting & self care• Have policies that support consultation• Have strong partnerships • Provide education to stakeholders PRIOR
to a mental health emergency
• Staff training in consultation & crisis intervention
• TRUST that counselors want to minimize risk to individuals AND the campus community
Recommendations for Consultants Cont’d
Questions & Discussion