Service Provision for Students with Mental Health Conditions:

The DS Perspective

Anna Barrafato and Gordon DionneAccess Centre for Students with Disabilities

July 18, 2014 2:30-4:30pm

Room: CC203

Agenda

Introduction DS Models: Setting the Frame Mental Health Conditions: Common

Symptoms and Diagnostic Features Academic Accommodations for Students

with Mental Health Conditions Case Studies

Setting the Frame

Social Model of Disability Medical Model

Interactional Model

Medical Social

Legal/Political Cultural

Individual

Campus Culture and Values

Policies & Codes

Interactions and Environment

Models of Disability Translation to Campus

The Art of Disability

“Disability is not a brave struggle or ‘courage in the face of adversity.’

Disability is an art. It’s an ingenious way to live."

- Neil Marcus

Mental Health Conditions: Common Symptoms, Diagnostic

Features and Academic Accommodations

Common Mental Health Conditions

Depression Anxiety Bipolar Disorder Obsessive Compulsive Disorder (OCD) Schizophrenia Borderline personality disorder Eating disorders PTSD Addictions

Depression

Common Symptoms and Diagnostic Features Depressed mood, diminished interest or pleasure

in activities, change of appetite, changes to sleep patterns, lack of concentration, fatigue, difficulty making decisions, suicidal ideation

What does it look like on campus? Appear dishevelled, miss appointments, tearful,

difficulty voicing their needs, late assignments, absences, long emails to professors, difficulty finishing exams on time, difficulty reading and following instructions, little class participation

AnxietyCommon Symptoms and Diagnostic Features Excessive anxiety and worry, difficulty controlling

worry/thoughts, feeling restless or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance, physiological symptoms

What does it look like on campus? Speak excessively fast, complain of physical

symptoms, complain that mind goes blank on tests, miss classes, avoid oral presentations, difficulty participating in class discussion, lateness, anxious around people

Bipolar DisorderCommon Symptoms and Diagnostic Features Cycling mood changes, manic symptoms: inflated

self- esteem or grandiosity, decreased need for sleep, more talkative than usual, flights of ideas, thoughts racing, distractibility, dangerous activities (i.e., shopping sprees, sexual indiscretions etc.)

What does it look like on campus? Stay up all night to study, speak excessively fast,

monopolize class discussion, difficulty paying attention in class, fidgety, impulsive responses in class, miss classes or appointments, sense that they have all the answers, drink lots of caffeine

Obsessive-Compulsive Disorder

Common Symptoms and Diagnostic Features Presence of obsessions, compulsions or both; recurrent,

persistent thoughts, urges or images (suppressed with some other thought or action); Compulsions are repetitive behaviors (i.e., hand washing) or mental acts (i.e., praying, counting) used in response to an obsession

What does it look like on campus? Difficulty getting to class as a result of performing many

rituals before leaving the home, absences, lining up objects on table before an exam, fear of interacting with classmates, repeated checking with professors about criteria for evaluation

Schizophrenia

Common Symptoms and Diagnostic Features Delusions, hallucinations, disorganized speech, grossly

disorganized or catatonic behavior, negative symptoms (i.e., diminished emotional expressions or diminished motivation in self-initiated purposeful activities)

What does it look like on campus? Disorganized, aloof in conversation, appear

preoccupied during conversations, may be late to appointments or class, appear dishevelled, frequent absences, may hand in assignments late, difficulty getting motivated, may get distracted easily during lectures, require handholding, difficulty making simple decisions

Borderline personality disorderCommon Symptoms and Diagnostic Features Pattern of instability in interpersonal relationships, self-

image, and affect, and marked impulsivity; avoid real or imagined abandonment, impulsivity, recurrent suicidal behavior, threats; mood swings; chronic feelings of emptiness

What does it look like on campus? Persistent lateness and absences; missed and late

assignments; inconsistent grades and academic performance; difficulty getting along in groups; inappropriate relationship with staff and/or faculty (i.e., saviour vs. aggressor “complex”); long-winded, highly emotional emails; sudden shifts in mood

Eating Disorders

Common Symptoms and Diagnostic Features Anorexia Nervosa: restriction of food, fear of

gaining weight, disturbance in self-perceived weight/body image; Bulimia Nervosa: binge eating, compensatory behaviors to prevent weight gain; Binge Eating Disorder: recurrent episodes of binge eating

What does it look like on campus? Lack of energy, depressed mood, difficulty with

focus, missed classes, lateness, late assignments, perfectionistic tendencies, difficulty completing assignments

PTSDCommon Symptoms and Diagnostic Features Recurrent, involuntary and intrusive distressing

memories, dreams, flashbacks of the traumatic event; intense psychological distress when triggered; changes in cognitions and/or mood; irritable behavior; self-destructive behavior, exaggerated startle response

What does it look like on campus? Persistent lateness and absences; missed and

late assignments; variability of grades on transcript ; dropped classes; difficulty in large groups and oral presentations; “triggers” can appear out of the blue

Addictions

Common Symptoms and Diagnostic Features Unsuccessful efforts to cut down or control

drug/alcohol use; time spent on obtaining alcohol/drugs; cravings or strong desire or urge to use; recurrent use resulting in failure to fulfill major work, home, or school obligations; continued use despite social or interpersonal problems

What does it look like on campus? Lateness and absences; missed and late

assignments; variability of grades on transcript; dropped classes; memory, concentration, or attentional problems; using drugs/alcohol prior to an exam or class

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Anxiety DisordersDepressiveBipolar and Related Disorders

Academic Accommodation

Perc

ent

of D

SOs

Most Common General Academic Accommodations:

Anxiety, Depressive, and Bipolar Disorders

0%10%20%30%40%50%60%70%

OCDTrauma and Stressor RelatedPersonalitySubstance RelatedEating DisorderSchizophrenia

Most Common General Academic Accommodations:

OCD, Trauma and Stressor, Personality, Substance, Eating Disorders, and Schizophrenia

Extra Time as an Exam Accommodation

Anxiety, Depressive, and Bipolar Disorders

25% more

time offered

33% more

time offered

50% more

time offered

75% more

time offered

100% more

time offered

Unlimite

d exam time

Other exa

m timing0%

10%

20%

30%

40%

50%

60%

70%

80%

AnxietyDepressiveBipolar and Related

Amount of Extra Time

Perc

ent

of D

SO

Extra Time as an Exam Accommodation:

OCD, Trauma and Stressor, Personality, Substance, Eating Disorders, and Schizophrenia

0%

10%

20%

30%

40%

50%

60%

70%

OCD

Trauma and Stressor Related

Personality

Substance Related

Eating

Schizophrenia

Amount of Extra Time

Perc

ent

of D

SOs

Most Common Exam Accommodations:Anxiety, Depression, and Bipolar Disorders

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

AnxietyDepressiveBipolar and Related

Most Common Exam Accommodations:OCD, Trauma and Stressor, Personality, Substance, Eating

Disorders, and Schizophrenia

Computer to ty

pe

Noise ca

ncelin

g headphones

Breaks

during exa

m offered

Altern

ate room (m

ore th

an 6 students)

Permitt

ed to lis

ten to m

usic

Room alone (single ro

om)

Small r

oom (less

than 6 students)

0%

10%

20%

30%

40%

50%

60%

OCDTrauma and Stressor RelatedPersonalitySubstance RelatedEatingSchizophrenia

Let’s Practise:Case Studies