Staff supporting students Mental Health Toolkit
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Take home messages
Occasional Situations
Distress can take many forms
On occasion, the distress faced by a student may exceed what you would consider to be within the range of a routine occurrence. Distress can take many forms and how you react may well be influenced by your own state of mind at the time and your memories of managing those emotions in the past.
Anger
Anger is a normal emotion which varies in intensity from mild irritation to intense rage. It can arise if a student feels:
- Unfairly treated
- Disappointed
- Worried
- Undermined
- Misunderstood
Anger can affect concentration, relationships, mood, work and social life. Sometimes it is linked with drug and alcohol problems. Anger becomes a problem if it harms the person involved or those around them. It can lead to aggression and aggression should never be tolerated. No excuses ever.
We can usually pick up when a student is angry even though the ways in which anger may be expressed are quite varied:
- Some people go red in the face while others go white
- Some may tremble or tap their hands and feet
- Others may be quite still and rigid
- You may notice them breathing quite rapidly or even holding their breath
- There could be outward displays of anger: shouting, banging a surface, threatening or yelling.
- You may notice more subtle behavioural changes where the student is sullen, sarcastic, belligerent or deliberately non-compliant with your requests.
Trust your gut. We are programmed to recognise anger and aggression.
Your key role in managing an angry student is to be sure that you are safe and to try to de-escalate the situation. The time to negotiate or rationalise with the student is not when they are angry.
Understandably, you may feel your own emotions building when dealing with an angry student:
- Try to stay calm and be aware of your own body language and tone of voice
- Try not to take things personally. The ‘lack of control’ lies with them, not you
If you are expected in your role to have regular contact with a student who seems to have anger management issues, clear boundaries can help. Call Campus Care on 4921 8600 if you require further advice.
- Set up your boundaries before the next appointment and stick to them: timing, place to meet, leaving door open, knowing a colleague is nearby.
- Have shorter appointments and warn them a few minutes before their time is up.
- Do not agree to any request which seems unreasonable or is unsustainable. If you feel pressured, say: “I’ll get back to you when I’ve had time to think about that.”
- Be aware of the manipulations sometimes exhibited by students who feel entitled.
- Try to respond to communications only within working hours.
- Don’t get caught into believing that you are responsible for solving their problem immediately.
Anxiety & panic attacks
We all experience stress and anxiety from time to time, and each of us has an optimal pressure-performance point. However, prolonged and excessive anxiety has potential to interfere with a student’s academic success, relationships and quality of life.
Anxiety in the form of panic attacks, constant worry, or unrealistic fears or phobias may indicate the student is experiencing an Anxiety Disorder. Anxiety conditions can be effectively treated and managed with therapy and/or medication.
A student may experience any of these signs and symptoms of:
Anxiety
- Physical: Heart racing,shortness of breath,dizziness,nausea,headaches,aches and pains
- Cognitive: Confusion, mind racing, loss of concentration or memory, preoccupied thoughts, mind blanking and indecisiveness
- Affective: Irritability or anger, unrealistic fears and worries and feeling nervous
- Behavioural: Avoiding situations, distress in social contexts and over-preparing
Panic attacks
- Sweating
- Nausea
- Dizziness
- Heart racing
- Chest pains
- Shortness of breath
- Shaking
- A dry mout
- Choking sensations
- Sense of being disconnected from one’s body or reality
A person may express fears of losing control, fainting or a sense of dread or foreboding. They may worry about recurrent panic and avoid situations where the panic arose.
- Discuss with students how anxiety can impact the student role, learning process and academic life cycle. They may avoid help seeking, sharing opinions in class, delivering presentations
- Invite students to develop proactive stress and anxiety management plans, and to seek counselling support early
- Appreciate that some students with severe conditions will need Reasonable Adjustment Plans (RAP) and invite students to send you their plans early in the semester
- Encourage students to approach fears in small increments in your classes, knowing they have a safe learning environment to risk making mistakes
- If a student ‘blanks out’ in group discussions, let them know that’s no problem and follow up later about resources available to assist
If a student has a severe panic episode in class:
- Respond in a calm and reassuring manner
- Try not to rush them and maintain focus on the present. Let them know symptoms will pass
- They may have some effective coping strategies in place already
- If the student can’t re-join the class, confirm their next immediate plan when they leave
- Be clear about the boundaries of your professional role
- Don’t hesitate to contact Counselling and Psychological Services (CAPS)
Reasonable Adjustment for Anxiety Disorders
Students who experience an Anxiety Disorders can register with AccessAbility to access a RAP.
For example, a RAP for a student with Generalised Anxiety Disorder (GAD) or Panic Disorder (PD) could include provisions for:
- Short breaks during tutorials
- Giving advanced notice and clear instructions about tutorial group activities
- Agreeing not to ask the student questions on the spot
- Alternative examination conditions
Crying
Crying does not necessarily signal that the student needs urgent help or that you are under pressure to solve their problem immediately. Rather like anger, whether we feel comfortable with managing a student who is in tears will depend upon the situation, our own histories and the options we have at the time. Some staff members are not fazed by tears; others see crying as an alert for immediate action. There’s no right or wrong; there just needs to be a sense that we are willing to help when the student settles sufficiently to let us know what’s going on for them.
We all know that life has its ups and downs. It is normal to react to these events. A student may:
- Be disappointed by the mark they received for an assignment
- Feel misunderstood by a close friend
- Be filled with self-doubt when their confidence is shaken
These feelings usually go away within a day or two. It is when feelings of intense sadness continue for weeks and begin to interfere with their daily functioning, that they may be suffering from depression. If the student alludes to a mental health condition, remember that you don’t need to understand the signs and symptoms in order to be of assistance to that student.
Tears may be related to any number of events, situations or mental states. At this point, let's assume this student tells you that they’ve been depressed. People experience depression in different ways. However, common symptoms may be divided into four groups. Not everyone experiences all these symptoms:
- Behavioural - No longer taking an interest in things that once gave them pleasure; social withdrawal; neglecting their responsibilities; finding everything more of an effort
- Emotional - Being easily upset or irritated; feeling flat, anxious, angry, guilty or sad
- Physical - Changes to sleeping and/or eating patterns; aches/pains; having little energy
- Cognitive - Being unable to concentrate, make decisions or remember things; being self-critical; having frequent thoughts about suicide or death.
Sometimes there seems to be a reason behind the depression and sometimes not. Being able to identify a cause may bring relief to some people, while others feel frustrated that understanding why they are depressed doesn’t make them feel any better.
Uncontrolled weeping is disconcerting for many of us. Usually the student will settle themselves, especially if you are able to take them to a quieter space where they are not observed. If they don’t appear to be settling, suggest that they focus on breathing out for as long as they can. As their tears subside, they will be able to breathe out for longer and longer.
- Ask what has helped in the past and see if they’re prepared to try one of these strategies. Encourage small, achievable steps.
- Don’t minimise their feelings with platitudinous statements like: “Well, it could be worse” or “Things will look better tomorrow.”
- Don’t be afraid to ask the student if they are thinking of hurting themselves if you think they could be suicidal. Evidence has shown repeatedly that asking about suicidal thoughts does not increase the risk of suicide.
Depending upon the reason they give you for the tears, it will usually be helpful to encourage them to seek support. Don’t offer them too many options since one of the symptoms of depressed mood can be confused thinking. Suggest they contact the Counselling and Psychological Services or make an appointment to see their own GP.
Grief & loss
Grief is a natural and healthy response to life’s losses. A student might be:
- Missing home
- Adjusting to separation or divorce
- Coming to terms with a chronic illness
- Mourning the death of a loved one
You will be able to imagine many other situations involving loss throughout one’s life.
Sometimes the loss is sudden or unexpected. There are no right or wrong ways to grieve, and family and cultural traditions play a part. As you know, grief is ‘messy’. Gradually, over time, the waves of emotional pain lessen, and a ‘new normal’ is established as one incorporates the loss.
You may observe students in shock, tearful, sad, irritable, distracted or withdrawn. It is likely their ability to study will be affected for a time. They might experience insomnia, loss of appetite, guilt and self-blame, or feel relieved. Some students may be coping with hidden sorrows they cannot share but you recognise signs of distress. Sometimes a current loss can trigger memories of past unresolved experiences.
If you notice signs of withdrawal, depression, aggression or risky behaviours, help the student to connect with professional support.
Listen with compassion and recognise the student’s loss. Knowing grief reactions is normal and can be reassuring to the student e.g. “I’m sorry for your loss. How can I help? If the loss was unexpected, the student may appreciate assistance to think through practical issues such as whom to inform at university. Suggest students contact relevant academics by email to explain their absence, and to request any work they may have missed.
- Students can contact Adverse Circumstances if they believe their studies have been affected.
- Some students will need to participate in important cultural or religious ceremonies.
- If a student has been away from your class, welcome them back warmly.
- Encourage students to take care of themselves – eat well, sleep, exercise – the basics matter even more.
- Daily routine often helps, and it is important that people don’t make impulsive decisions about major life changes.
- People need to know they are not alone and that talking about the loss can help.
- Confirm the student has supports in place; friends and family, counselling or Chaplaincy if they wish.
- Some students may become isolated if they are not attending classes and their family is overseas.
- Occasionally a student will need to withdraw from one or courses.
- Please note, if a student or colleague passes away, contact Counselling and Psychological Services (CAPS) for additional support and resources.
If you have experienced a recent loss, remember to take care of your own wellbeing first.
Lack of sleep
Getting sufficient sleep is fundamental to good mental health. It’s not unusual to experience occasional periods of difficulty sleeping but consecutive nights of insomnia can result in the plummeting of mood. Indeed, the worsening of symptoms for students who cope with a mental health condition often begins by getting insufficient sleep.
What is regarded as “sufficient sleep” depends on the individual but a healthy young adult requires generally between 7 to 9 hours.
A clear sign that the student is suffering from sleep deprivation is excessive sleepiness during the daytime. Falling asleep in your class or in the library is a bit of a give-away!
Symptoms include:
- Yawning a lot
- Moodiness
- Being forgetful
- Sudden changes in academic behaviour (not attending tutorials, being late to hand in assignments)
- Difficulty concentrating or learning new material
- Clumsiness
- Lack of motivation
- Irritability
- Lapses in memory
Reassure the student that there are resources available to help them improve their sleep patterns. For example, if they aren’t sleeping because they are worried or anxious - a common problem for our students - the ANU: e-Couch Anxiety and Worry Program which provides evidence-based information, self help tools and toolkits.
Tell them that it is important to remember that when they are sleep deprived, it is not a good time to be making big decisions which could have longer term consequences – decisions like changing a course or giving up tertiary studies.
Loneliness
Social isolation is a powerful predictor of poor mental wellbeing for university students. Making meaningful social connections can help those students feel more connected with the university community. Feeling connected enhances the student experience.
To feel connected, supported and loved is a basic human need. For some students, coming to university means leaving behind important connections and trying to establish new ones. This is not always a smooth journey.
- Physical symptoms – aches and pains, headaches, illness or worsening of medical conditions
- Mental health conditions – increased risk of depression, anxiety, paranoia or panic attacks
- Low energy – tiredness or lack of motivation
- Sleep problems – difficulty getting to sleep, waking frequently or sleeping too much
- Diet problems – loss of appetite, sudden weight gain or loss
- Substance use – increased consumption of alcohol, smoking, medications, drugs
- Negative feelings – feelings of worthlessness, hopelessness or thoughts about suicide
(Resourced from: https://www.lifeline.org.au/get-help/topics/loneliness-isolation)
- Reassure the student that it’s not uncommon to feel lonely at university and that things can change.
- Explain that beginning the process of changing their level of social connection takes a bit of energy but that they shouldn’t wait until they feel better before taking some action. By speaking with you, they have already begun that journey.
- Encourage them to think about a couple of options like a club or social group they could explore and see whether they are prepared to make a commitment to themselves to take one small step towards one of those options.
Coping with a relationship breakup
Young adulthood is a time for exploring romantic relationships, and relationship breakups are common during university years.
- It will be harder if the breakup was unexpected or the other party moves on quickly, not to mention healing a broken heart after a first serious relationship.
- Longer-term partnerships can also come under pressure when students devote more attention to their studies.
- Early signs of relationship strain include spending less quality time, recurring arguments and unresolved conflict.
When a relationship ends, often the first month or so is the hardest. It’s normal to feel sad, hurt and angry, and sometimes emotions are overwhelming. Students may express regret, guilt and self-blame, or blame their ex-partner for a time.
Some students will become preoccupied with why the relationship ended, increasing their emotional distress. Feelings of rejection can trigger temporary loss of self-esteem. A recent relationship loss is a risk factor for a first depressive episode and thoughts of suicide.
When a long-term partnership ends, there are likely be practical, financial and legal issues to address. Around half of all relationships resume for a time, and this causes problems when only one party is keen to leave the relationship again permanently.
- Try to respond with compassion and normalise the grief process.
- Don’t assume your student’s gender or sexual orientation.
- Support health coping and self-care strategies as well as contact with friends and family.
- Offer counselling contacts, particularly if the student continues to experience distress six months post-separation or when they show signs of depression.
- The student may need to reduce their academic load or withdraw from courses. If so, consulting about program pathways is often helpful.
- Suggest students set short-term goals, break study sessions into smaller blocks and focus on subtasks to aid concentration.
- You may like to remain quietly optimistic for them while they begin to reflect on what they’ve learned from their experiences.
Please take note if the student reports:
- Pressure to make an unreasonable level of commitment when they’re just entering a new relationship.
- Saying 'no' to a relationship but the other person ignores their request.
- Signs of abuse such as being controlled, isolated, criticised, pushed or injured.
- An ex-partner is texting numerous times a day and making threats.
- Fixation on an ex-partner, stating they can’t let go of the relationship.
If a student confides to you, give clear messages they have the right to be safe and to make relationship choices that work best for them. Let the student know you can connect them to specialised professional support – in person, by phone or online.
If a student shares traumatic relationship experiences, think about what you need to do to take care of yourself.
Self harm
During their lifetime, around 8% of adults will self-harm by deliberately injuring themselves. People self-injure for different reasons; most commonly to control, relieve or express distressing emotions, thoughts or images. Sometimes there has been a recent stressor but not always.
Self-injury can be a one-off behaviour, or a repeated coping strategy; in which case the cycle may be hard to break. Rarely is the person seeking attention, nor are they attempting to kill themselves, however accidental deaths do occur.
You may notice frequent, unexplained injuries such as:
- Cuts
- Scratches
- Burns
- Scars
- Attempts to conceal them.
Sometimes people have fractures from hitting themselves against hard surfaces or they may self-poison. Skin injuries can go untreated due to shame and embarrassment, risking infection.
Depending on your role, consider approaching the student to share your concerns. Self-injury is usually private and hard to talk about, so try to be patient and listen with respect and interest. Don’t pressure the student to talk about changing their self-injurious behaviour. However, let them know there are alternatives to self-harm if they seem curious.
- Whenever you have concerns about a student self-injuring, contact CAPS, Campus Care, or the UON After-Hours Support Line for advice.
- Self-injury may be a symptom of a mental health problem which is treatable.
- People who self-harm are more at risk of suicide. It’s ok to ask directly whether they are having thoughts of suicide.
- Reassure the student that professional help is available.
- If you encounter a student self-injuring, try to respond in a calm, supportive manner.
- Determine whether they require medical attention. For example, do they have a gaping cut or a burn?
- If the person’s injuries appear severe, they express suicidal intent, or state they have taken an overdose of medication or poison (ask what they’ve ingested) then contact Emergency Services on triple zero (000) for an Ambulance and call Security
- Depending on the nature of student disclosures and injuries, you may feel shocked, distressed or angry, and these are natural reactions.
- Try to avoid expressing strong feelings when you are with them, however, please access debriefing and support afterwards if you wish.
Suicidal thoughts
Having suicidal thoughts is different from planning how to die. Suicidal thoughts are often an indication that life at the moment seems unbearable and that something needs to change.
A person having suicidal thoughts may feel trapped by their circumstances and unable to think of another way out. The thoughts may be constantly with them or may be very fleeting. Having thoughts about suicide could be associated with a mental health condition - but not necessarily.
If the student has clear intent to act upon their thoughts, call 000 and then call Security.
It may be difficult for you as a staff member to observe these behaviours so listen out for references to these signs and symptoms.
Behaviours:
- Withdrawal from friends
- Alcohol or drug misuse
- Quitting activities which were previously important
- Putting affairs in order
- Writing goodbye letters
- Prior suicidal behaviour
Feelings of:
- Hopelessness
- Loneliness
- Disconnection
- Worthlessness
- Shame
Thoughts of:
- Being helpless: “Nothing I do makes a bit of difference and no one can help me.”
- Feeling trapped: “I can’t see any way out of this mess.”
- Feeling like a burden: “They’d be better off without me.”
- Lack of belonging: “I just don’t fit in anywhere.”
- Hopeless: “What is the point? Things are never going to get any better.”
(Resourced from Beyondblue)
You won’t “put the idea into their head” if you ask direct questions about what appear to be suicidal thoughts. Talking about suicidal thoughts often breaks a secret, brings relief and is the first step towards getting help.
Suicidal thinking does not necessarily mean that the student wants to die. There is a difference between thoughts and action. More commonly, thoughts of suicide indicate that their lives are currently unbearable and they don’t want to go on living the life they have as it is at the moment.
If you are comfortable with doing so, it is useful to find out whether they have a plan for ending their life, whether they have attempted suicide in the past and whether they have begun to prepare actively for their deaths. If you get affirmative answers, treat this as an emergency and get urgent help. Call Emergency Services on 000. The number for Security is on the back of your Staff Card.
Often the key is to provide some hope that things can change. Is there one aspect of their lives causing particular distress? For example, are they feeling completely overwhelmed and trapped by academic demands? A discussion about one small step in that area can bring them hope.
Please note, if you need additional support, contact UON After Hours Support Line or Campus Care.
It can be highly distressing to be with a student who is expressing suicidal thoughts even if they have reassured you that they won’t act on these thoughts. Take care of yourself and seek help from a trusted friend who’ll allow you the time you need to debrief.
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