A Guide for HKUST Faculty and Staff PROMOTING STUDENT MENTAL HEALTH: A STATE OF WELL-BEING THE HONG KONG UNIVERSITY OF SCIENCE AND TECHNOLOGY COUNSELING AND WELLNESS CENTER ॷ෫ऋσᏰ ᏰҡሄᏲϛЖ
Promoting Student Mental Health: A State of Well-being A Guide for HKUST Faculty and Staff 1
3 2 Promoting Student Mental Health: A State of Well-being Promoting Student Mental Health: A State of Well-being TABLE OF CONTENTS Greetings! 6 Introduction 7 Dedication 8 Acknowledgments 9 CHAPTER ONE: RECOGNIZING STUDENTS IN DIFFICULTIES AND DISTRESS 10 Mental Health Trends to Watch 12 Student Mental Health 3-Tier Intervention Model 22 Conversation Starters 24 CHAPTER TWO: WARNING SIGNS OF DISTRESS 26 Academic Changes 29 Physical Changes 29 Mood and Behavioral Changes 30 CHAPTER THREE: APPROACHES IN HANDLING STUDENTS IN DISTRESS 31 When You Talk to a Student 34 When Should You Make a Referral? 36 When The Student is Showing Aggressive Behaviors or Suicidal Urges 38 Emergency Contacts 41 Care for Hospitalization 42 CHAPTER FOUR: DIVERSITY ON HKUST CAMPUS 44 Respect and Sensitivity 47 Students with Special Educational Needs (SEN) 49 • Physical Disabilities 50 • Chronic Health Problems 50 • Learning Disabilities 51 • Psychiatric Disorders 52 • Attention Deficit/Hyperactivity Disorder (ADHD) 53 • Autism Spectrum Disorders (ASD) 53 Sensitivity to LGBTQ Students 54 CHAPTER FIVE: SUPPORTING STUDENTS WITH MENTAL HEALTH DIFFICULTIES 55 Supporting Students with Mental Health Difficulties 56 Challenges and Struggles that Students Experience 58 • University Life Adjustment/Transition 58 • Academic Stress and Difficulties 58 • Peer Pressure or Interpersonal Difficulties 59 • Technology Impacts 60 • Love Relationships and Sex-related Concerns 60 • Family Related Problems 61 • General Health Concerns 62 • Personal Growth and Development 62 • Career Development and Planning for Future 63 Major Mental Health Concerns that Students Present and the Support They Need 65 • Emotional Distress n Anxiety and Stress 66 n Depression 68 n Grief and Bereavement 71 n Trauma/Crisis 74 n Disordered Eating 76
5 4 • Behavioral Concerns n Substance Abuse and Addictive Problems 78 n Excessively Demanding and Dependent Behaviors 80 n Self-injury 82 • Concerns that Require Immediate or Urgent Attention n Suicide 84 n Physical Violence and Aggressive Behaviors 86 n Poor Contact with Reality 88 Responding to Students with Emotional Distress and Behavioral Concerns 91 • What You Can Do 92 • What to Avoid 94 Responding to Students with Concerns that Require Immediate or Urgent Attention 98 • What You Can Do 99 • What to Avoid 100 Responding to Student Death 102 • Verifying Death and Cause 104 • Disseminating Information 104 • Supporting Those Impacted by the Student Death 106 • Memorials 110 CHAPTER SIX: SUPPORTING POSTGRADUATE STUDENTS 112 Postgraduate Students: A Vulnerable Population 113 Supporting Postgraduate Students 117 • Early Clarification and Ongoing Management of Expectations 119 • Identification of Your Supervisory Style and its Impacts on Students 121 • Respecting Diversity, Value Students’ Priorities and Need for Balance 122 • Effective and Supportive Feedbacks and Constructive Criticisms 125 • Making Yourself Approachable with Regular Check-in with Students 127 • Identifying Students Struggling with Personal Concerns 128 • Supporting Towards Thesis Defense 129 • Supporting Students for Careers in the Academia or Beyond 130 • When Relationships with Students Go Wrong 131 • Being Generous on Encouragement and Support 133 • Eleven Practices of Effective Postgraduate Supervisors 135 • In Case of Mental Health Problems 136 • In Case of Termination 137 Promoting Student Mental Health: A State of Well-being CHAPTER SEVEN: WHAT FACULTY AND STAFF CAN DO? 138 Am I One of the Undue Stressors? 139 Helping Students to Identify and Manage Overwhelmed Stress 140 Connecting with Your Students 143 Evaluating Students without Causing Unnecessary Distress 144 Prevention, Early Identification and Crisis Management 145 It’s Okay to be Not Okay 147 Speaking Openly about Mental Health, Encouraging Mental Support and Help-Seeking 148 Paying Attention to Abnormal Absentees 150 Students Taking Study/Sick Leave Due to Health Reasons 151 Students on Academic Probation or Subject to Dismissal 152 Making Staff Referrals 153 CHAPTER EIGHT: FACULTY AND STAFF TESTIMONIALS 154 CHAPTER NINE: WEBSITES AND RESOURCES RELATING TO MENTAL HEALTH 171 Global Websites 172 Local Websites 173 HKUST Psychoeducational Resources 174 Counseling and Wellness Center 176 Mood and Stress Assessment 178 Promoting Student Mental Health: A State of Well-being
7 6 GREETINGS! Dear Colleagues, Warmest greetings from the Counseling and Wellness Center! We are grateful that for many years, you have been our partners in promoting the mental health and well-being of our students. As the student population increases and their life grows in complexity, we need to refresh our cooperative endeavour. We hope this guide would provide some directions in recognizing and managing our students’ personal difficulties, and equip you with the ability and readiness to prevent, detect and handle these difficulties. Thank you in advance for taking the time to read this guide. We believe you are in a unique position as an excellent observer to notice and assist in the early stages of emotional distress among the students you have direct or indirect contact with. Our joint effort is indispensable for building a caring, nurturing and stigma-free learning environment! Promoting Student Mental Health: A State of Well-being INTRODUCTION Mental health is a crucial element for a fruitful university life of students. It is the responsibility of all university staff to promote mental well-being and incorporate relevant practices as part of the regular institutional operations. It is also the university’s goal to develop a supportive, accepting and well-informed university community that respects all individuals in the promotion of mental health and well-being. Based on our clinical experience, we have found that academic, interpersonal and emotional problems faced by students are becoming more complicated and severe, thus rendering their management more challenging. Thorough understanding in handling problematic and critical incidents is therefore essential and beneficial because it guides our coordinated efforts to address student issues. Effective communication, coordination and cooperation among relevant units and personnel in our University are necessary. Together, let us: • Make proactive and strategic decisions to respond to students in distress and at potential risks; • Implement theoretically-grounded and empirically-validated interventions through psychoeducation, mental health training, prevention programs, and timely assistance for high-risk students; and • Establish a comprehensive institutional approach to foster a healthy and respectful learning environment by delivering a spectrum of psychological services, to deploy resources for authentic impacts, as well as to revise administrative practices that can deliver clear information for internal and external constituents. Promoting Student Mental Health: A State of Well-being “Mental health is a crucial element for a fruitful university life of students.”
9 8 DEDICATION This guide is dedicated to all HKUST students who have or who will be facing emotional distress, loneliness and disappointment. We hope that it will normalize help-seeking and de-stigmatize psychotherapy and counseling. Promoting Student Mental Health: A State of Well-being Promoting Student Mental Health: A State of Well-being “ May everyone be happy and safe and may their hearts be filled with joy. May all living beings live in security and peace. May all of them dwell in perfect tranquility. ” Thich Nhat Hanh ACKNOWLEDGMENTS This guide is a collection of knowledge and best practices from our colleagues at the Counseling and Wellness Center. We would like to express our sincere gratitude to many teams of professionals who have contributed their efforts wholeheartedly. Prof Nancy Ip President The Morningside Professor of Life Science Chair Professor, Division of Life Science Dr Lian Bai Manager, International and Mainland Programs, School of Humanities and Social Science Prof Ben Chan Associate Professor of Engineering Education Senior Lecturer, Department of Civil and Environmental Engineering Prof King Chow Professor, Division of Life Science Acting Dean of Students, Dean of Students’ Office Dr Ice Ko Associate Professor of Science Education Lecturer, Division of Life Science Mr Miguel Ladao Lecturer, Center for Language Education Prof Henry Lam Associate Head and Associate Professor, Department of Chemical and Biological Engineering Dr Kelvin Mak Senior Lecturer, Department of Accounting Prof Ekkachai Saenyasiri Associate Professor of Business Education Senior Lecturer, Department of Finance Prof Bertram Shi Professor, Department of Electronic and Computer Engineering Prof Shenghui Song Assistant Professor, Division of Integrative Systems and Design Assistant Professor, Department of Electronic and Computer Engineering Prof Kellee Tsai Dean of Humanities and Social Science Chair Professor, Division of Social Science Ms S.Y. Elaine Wong Lecturer, Center for Language Education Prof Kam Tim Woo Associate Professor of Engineering Education Senior Lecturer, Department of Electronic and Computer Engineering Dr Silver Chan Head, Counseling and Wellness Ms Vava Kwok Senior Student Counselor Editorial Consultant Dr Isaac Tam Clinical Psychologist
11 10 Chapter One: Recognizing Students in Difficulties and Distress Chapter One: Recognizing Students in Difficulties and Distress New experiences in university are exciting but sometimes can also be stressful causing abnormal thoughts and behaviors. Have you witnessed or heard about these scenarios? • A student cries out in your class with disruptive behaviors, derogatory language or threatening words. • A student tells you that he/she has suicidal thoughts and asks you to keep the secret. • A student reveals that he/she has been sexually assaulted and stalked by acquaintances and feels scared, shameful, guilty and frustrated. • A student, who used to be punctual in classes and well-behaved in assignments and examinations, is observed having frequent absences, being overly talkative, unusual delaying in handing in assignments, having conflict with classmates, learning with unexpected difficulty, being emotionally unstable, and withdrawing from others. • A student is being bullied and discriminated because of his/her sexual identity, gender identity, race, disability or family status. As a leader or key teaching contact to the students, you are in a unique and crucial position to be an excellent observer of students who are in distress and can give direct care readily. “As a leader or key teaching contact to the students, you are in a unique and crucial position to be an excellent observer of students who are in distress and can give direct care readily.”
13 12 Chapter One: Recognizing Students in Difficulties and Distress Chapter One: Recognizing Students in Difficulties and Distress References http://www.who.int/mediacentre/factsheets/fs220/en/ http://www.who.int/maternal_child_adolescent/topics/adolescence/mental_health/en/ MENTAL HEALTH TRENDS TO WATCH Global Spotlight on Mental Health The World Health Organization (WHO) states that mental health is an integral and essential component of health. Its constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2016). An important implication is that mental health is more than just the absence of mental disorders or disabilities. It is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to community. It was estimated worldwide that up to 20% of children and adolescents experience various severity of mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. Neuropsychiatric conditions are the leading cause of disability in young people in all regions. If untreated, these conditions severely influence one’s development, educational “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” attainments and potential to live a fulfilling and productive life. Students with mental disorders often face stigma, isolation and discrimination, as well as the lack of access to health care and education facilities, in violation of their fundamental human rights. Public mental health is a valuable asset for the whole world. To promote global awareness, World Mental Health Day is observed on 10 October every year, with the objective of raising awareness of mental health issues and mobilizing efforts in support of mental health, including preventive measures and post-diagnosis rehabilitation services that are essential for resumption of normal life. The symptoms of mental disorders listed in this guide are made reference to two international standard diagnostic tools, the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association and the eleventh revision of International Classification of Diseases (ICD-11) maintained by the WHO.
15 14 Chapter One: Recognizing Students in Difficulties and Distress Chapter One: Recognizing Students in Difficulties and Distress Hong Kong Spotlight on Mental Health In Hong Kong, the Department of Health undertakes a role in promoting mental well-being by enhancing public awareness through education and publicity using a life-course and settingbased approach. Since 2016, a three-year territory-wide Campaign, Joyful@HK has been launched to engage the public with three main themes: “Sharing”, “Mind” and “Enjoyment”. Mental disorders with high local prevalence were selected to increase understanding and reduce stigma. The Child and Adolescent Psychiatric Team of the Hospital Authority reported more than 50% of increase in case load from 18,900 in 2011-2012 to 28,800 in 2015-2016. In particular, psychosis tends to become apparent in late adolescence and early adulthood. Another highlight is the Mental Health Ordinance set out in Chapter 136 of the Law of Hong Kong. Specific clauses related to the treatment of psychiatric illness in hospital and community are under Part 3 and Part 4: Learn more about the CAP 136 Mental Health Ordinance at http://www.hklii.hk/eng/hk/legis/ord/136/ • Part 3 Section 31 Detention of a patient under observation • Part 3 Section 42A Discharge of patient • Part 3 Section 42B Conditional discharge of patients with propensity to violence • Part 3B Supervision and treatment orders • Part 4B Guardianship “Since 2016, a three-year territory-wide Campaign, Joyful@HK has been launched to engage the public with three main themes: “Sharing”, “Mind” and “Enjoyment”.” Reference Tsang, E. (2017, April 19). Study reveals need for psychiatric services in Hong Kong, but also warns against forcing treatment on mentally ill. South China Morning Post. Retrieved from http://www.scmp.com/news/hong-kong/health-environment/article/2088626/studyreveals-need-psychiatric-services-hong-kong
17 16 As shown in the final report of the Committee on Prevention of Student Suicides (2016) submitted to the Government of Hong Kong Special Administrative Region, suicide incidents among students involved multiple contributing factors and causal pathways. Many incidents involved two (52%) or three (37%) areas of concerns: Further, the 2016 review from the National Alliance on Mental Illness and Jed Foundation in the United States summarized that starting conversations are important to address mental health concerns for university students. It can be approached in four aspects: mental health conditions are common, common signs of a mental health condition, mental health on campus, and health information confidentiality. Chapter One: Recognizing Students in Difficulties and Distress Chapter One: Recognizing Students in Difficulties and Distress Reference Kopec, M. T., Randel, J., Naz, B., Bartoces, M., Monsur, J., Neale, A. V., & Schwartz, K. L. (2010). Using the guidelines for adolescent preventive services to estimate adolescent depressive symptoms in school-based health centers. Clinical Research and Methods, 42, 193-201. References Committee on Prevention of Student Suicides. (2016). Final report. Retrieved from https://www.edb.gov.hk/attachment/en/ student-parents/crisis-management/about-crisis-management/CPSS_final_report_en.pdf The Jed Foundation. (2017). Starting the conversation: College and your mental health. Retrieved from https://www. jedfoundation.org/wp-content/uploads/2017/11/jed-nami-guide-starting-conversation-college-mental-health.pdf “Mental health concerns for university students can be approached in four aspects: mental health conditions are common, common signs of a mental health condition, mental health on campus, and health information confidentiality.” of students reported depressive symptoms 26.5% of students reported a history of suicidal ideation 8.5% of students felt sad, down or hopeless 25.1% Student Mental Health Trends While traditionally the mental health concerns of university students stem from school adjustment, relationships, homesickness and unsatisfactory academic performance, mental health problems of students are now more frequent, diversified and complicated. According to the Mental Health Review Report 2017 published by the Food and Health Bureau, the overall prevalence estimate of mental disorders among the sampled adolescents in Hong Kong was 16.4%. In another paper prepared by Kopec, et al. (2010), adolescents have high rates of depressive symptoms and suicidal behaviors: about relationship problems (family and peer relationship) 87% about adjustment difficulties (study and family related adjustment) 82% about psychological concerns (self-harm and suicidal ideation, negative thinking) 63% about mental health 18%
19 18 Chapter One: Recognizing Students in Difficulties and Distress Chapter One: Recognizing Students in Difficulties and Distress HKUST Student Mental Health Trends Our University has its own mental health concerns. Every year, all undergraduate freshmen are invited to complete an assessment (Depression, Anxiety and Stress Scales, DASS) on their levels of anxiety, depression and stress at the beginning of the academic year. The percentage of freshmen who reached a moderate or above level of anxiety, depression and stress in the academic year of 2020-2021 are 48.56%, 31.58% and 22.42% respectively (N = 2,752). The percentage of freshmen who reached a moderate or above level of anxiety, depression and stress in academic year 2020-2021: “ I suffered. Some nights I could not get to sleep, because the voice kept reminding me of how imperfect I was. Past mistakes made in relationships and at work came up in my head relentlessly. When I realized the first thing that popped up in my head after I woke up in the morning was the inner, negative voice of self-hatred, I thought that I had to do something about myself. I was scared that I would not be able to change and be stuck in this situation forever. However, I did not want to be a slave of my own negativity that had been affecting me for years. This had to stop. ” ~ Anonymous Student ~ MODERATE OR ABOVE LEVEL OF ANXIETY 48.56% MODERATE OR ABOVE LEVEL OF DEPRESSION 31.58% MODERATE OR ABOVE LEVEL OF STRESS 22.42%
21 20 Chapter One: Recognizing Students in Difficulties and Distress Regarding counseling service usage, the number of counseling clients has nearly tripled (+290%) in the past eight academic years from 2012 to 2020. Increasing trends of usage are observed in all academic profiles, including undergraduate students, research and taught postgraduate students. Another key trend on our campus is that the awareness for psychological services has been increasing in the student community. With the dedicated support from different stakeholders in the University, a variety of training programs, workshops and psychoeducation activities have been initiated. In the academic year of 2019-2020, a total of 159 psychological health initiatives have been delivered with more than 21,300 headcounts of students participated. Concerted efforts have also been put to enhance crisis prevention, to reduce the stigma of meeting with psychologists and counselors, as well as to strengthen the collaboration with other helping professionals including psychiatric doctors and crisis counselors from the community. “Another key trend on our campus is that the awareness for psychological services has been increasing in the student community.” Chapter One: Recognizing Students in Difficulties and Distress
23 22 Chapter One: Recognizing Students in Difficulties and Distress Chapter One: Recognizing Students in Difficulties and Distress STUDENT MENTAL HEALTH 3-TIER INTERVENTION MODEL The Education Bureau of Hong Kong encourages schools to adopt a three-tier intervention model for providing additional learning support to students based on their individual needs. TIER 3 Intensive and individualized support to students with persistent and severe learning/behavioral adjustment difficulties TIER 1 Help students with mild or transient learning/behavioral adjustment difficulties TIER 2 “Add-on” intervention for students with persistent learning/behavioral adjustment difficulties TIER 3 : CRITICAL SERVICES Outlines the critical mental health services that need to respond fully to fundamental student mental health needs in the university community, aiming at reducing reaction time and providing timely crisis prevention services TIER 2 : TARGETED INTERVENTIONS Targets at a smaller group of at-risk students through psychoeducation, prompt support and prevention programs, restores key services to support students in reducing distress and improving psychological well-being TIER 1 : COMPREHENSIVE APPROACH Enhances the full spectrum of student life services to creating a healthier and conducive learning environment through engaging faculty and academic staff, and facilitating effective communication and collaboration among multi-disciplinary helping professionals References Mental Health Review Report http://www.hpdo.gov.hk/doc/e_mhr_full_report.pdf School Crisis Management http://www.edb.gov.hk/en/student-parents/crisis-management/about-crisis-management/index.html Prevention of Student Suicides https://www.edb.gov.hk/en/teacher/prevention-of-student-suicides/overview.html University of California – Promoting Student Mental Health http://www.ucop.edu/student-mental-health-resources/_files/pdf/PSMH-guide.pdf
25 24 Chapter One: Recognizing Students in Difficulties and Distress CONVERSATION STARTERS Many people are not aware that there are two types of stress: eustress and distress. Eustress is the good stress that could motivate us to continue to enjoy studying and working. Distress, on the contrary, is when the stress turns too much to sustain, bear or cope with, and eventually results in physiological, behavioral, cognitive and emotional symptoms. Our students may experience both eustress and distress throughout their university years. Along the journey, they not only have to juggle rigorous academic demands, but also to cope with developmental challenges such as new relationships and friendships, as well as new responsibilities from family and peer network. Feelings of anxiety, isolation, rejection, refusal, mistrust, helplessness or even hopelessness are not uncommon among students at certain moments. They may also feel disconnected in attempting to deal with grief, loss, emotional or physical abuse, trauma and other psychological disorders. All these multiple stressors may result in serious daily dysfunctions or maladjustments of their academic performance, interpersonal life, and life goals. “Starting a mental health conversation is beneficial. Even for the most serious psychological problems, there is a high rate of recovery or good prognosis if proper treatment can be rendered.” Starting a mental health conversation is beneficial. Even for the most serious psychological problems, there is a high rate of recovery or good prognosis if proper treatment can be rendered. Unfortunately, some students just fail or procrastinate to get immediate support they need for various reasons, such as insufficient knowledge about the early warning signs of symptoms, denial or stigma of mental illness, lack of information about campus and community resources, as well as doubts on the confidentiality of the discussions. Chapter One: Recognizing Students in Difficulties and Distress
27 26 Chapter Two: Warning Signs of Distress “Learning more about the signs and indicators of distress could allow you to identify students in need, direct them to appropriate resources and support them in a timely manner.” As a faculty or staff, you have daily interactions with numerous students and close connection with some of them. It is likely that you are the first to notice a student who is experiencing difficulty. You do not need to take on the role of a counselor or try to diagnose a student. But learning more about the signs and indicators of distress could allow you to identify students in need, direct them to appropriate resources and support them in a timely manner. The following categories of warning signs usually appear repeatedly to draw your attention. The presence of one sign alone does not necessarily mean that the student is experiencing severe distress. However, the more signs you observe, the more likely the student needs help. Chapter Two: Warning Signs of Distress
29 28 Chapter Two: Warning Signs of Distress Chapter Two: Warning Signs of Distress ACADEMIC CHANGES • Written or verbal expression of despair, suicide, death, violence or social isolation* • Repeated absences from classes, laboratories or tutorials • Deterioration in quality or quantity of work • Missed assignments, examinations or appointments • Disproportionate response to grades or evaluations PHYSICAL CHANGES • Noticeable cuts, bruises or burns* • Disorganized speech, rapid or slurred speech, confusion* • Deterioration in physical appearance or personal hygiene • Marked weight loss or increase • Particularly drawn or tired looking • Noticeable smell of alcohol or illicit drugs • Bizarre, unusual and out of character dress • Inability to make eye contact *Safety Risk Indicators: Immediate attention is needed. “ Two years ago, I was a year one student who got lost and depressed. I disliked people around me. I hated my family and my “jongmates”. I did not want to do anything and failed two core subjects in that semester. I tried to transfer to other majors in order to restart my university life. As expected, the transfer was not successful because of my poor results. I was not able to quit because my family was poor. I could not get into sleep easily. I quit the society cabinet finally. I really needed someone’s help and so I went to seek counseling. ” ~ Anonymous Student ~
31 30 MOOD AND BEHAVIORAL CHANGES • Expressions of hopelessness or worthlessness, crying or tearfulness* • Hearing voices or seeing things that do not exist* • Physical or verbal aggression to self, others, animals or properties* • Personal disclosure about general distress, family conflict, grief, loss, or financial hardship • Loss of interest in most things or exaggerated interest in some things • Expressions of severe anxiety or irritability • Shakiness, tremors, fidgeting or pacing • Significant mood swings • Angry or hostile outbursts, yelling, or aggressive comments • Agitation or restlessness • Feelings of disorientation or acute loneliness • Over-intense interaction, withdrawal or reduced concentration • Uninhibited, disruptive or disturbing behaviors • Disrupted pattern of sleep or eating *Safety Risk Indicators: Immediate attention is needed. Chapter Two: Warning Signs of Distress Chapter Three: Approaches in Handling Students in Distress
33 32 Chapter Three: Approaches in Handling Students in Distress Chapter Three: Approaches in Handling Students in Distress Now that you are aware of the warning signs of distress, let us discuss when and how you should respond. When you notice that your student is having one or more of the warning signs, having a simple check-in with the student may help you get a better sense of his/her situation. There is no harm in offering resources to a student who is not in need; but there can be serious consequences for failing to follow through with your observations. “There is no harm in offering resources to a student who is not in need; but there can be serious consequences for failing to follow through with your observations.” “ In my two years of studies, I faced many difficulties. I was challenged by my tutor about my class participation in one of the courses. When I answered the questions, I always raised my hands first, looked at her, as a signal that I could answer her questions, and marked down how many questions that I had answered. No matter how hard I tried to make her understand that I did answer so many questions, she still did not believe me. I felt extremely frustrated. ” ~ Anonymous Student ~
35 34 Chapter Three: Approaches in Handling Students in Distress Chapter Three: Approaches in Handling Students in Distress LISTEN WITH EMPATHY RESPECT CONSULT UNDERSTANDING WITHOUT JUDGING TRUSTFUL SOURCES OF SUPPORT If the student does not want to talk about his/her problem, do not ask intrusive questions. Respect his/her right not to discuss things. Invite the student to come back at some future time to talk again. If you are very concerned about a student who has refused help, consult your head or supervisor, or contact our Counseling and Wellness Center for advice with due consideration for confidentiality. Approach in an understanding way by informing the student privately and tactfully about your concern, basing your comments on observable behavior and trying not to be alarmist in your language. Ask open-ended questions that deal directly with the issues without judging. Listen with empathy to find out what is bothering the student. Try to identify which aspects of the student’s study are causing stress, and check or negotiate around class attendance and deadlines to submit assignments. Explore gently with the student some trustful sources of support within and outside the university. Establish whether the student has any practical or emotional support, and encourage the student to seek appropriate assistance. WHEN YOU TALK TO A STUDENT When you approach a student, express your care and concern in a supportive and non-intrusive manner. Here are some clues:
37 36 WHEN SHOULD YOU MAKE A REFERRAL? Your support and understanding of the students is essential and can make a great difference to their emotional well-being. But do not overburden yourself and do not expect yourself to take up the role of a psychologist or counselor. There are times when making referral is necessary: “Your support and understanding of the students is essential and can make a great difference to their emotional well-being.” Chapter Three: Approaches in Handling Students in Distress Chapter Three: Approaches in Handling Students in Distress When you feel overwhelmed and overly responsible for or worried about the well-being of the student. When the student and you have personality differences or conflicts that cannot be resolved and may interfere with the helping process. When the student asks for assistance with a problem that is outside your expertise or responsibility. When helping the student with the problem will compromise or change the status of your relationship with him/her, e.g., asking for money or a place to live. When the student is repeatedly reluctant to discuss his/her problem with you. When the assistance and support you have already provided do not seem to solve the student’s problem effectively.
39 38 WHEN THE STUDENT IS SHOWING AGGRESSIVE BEHAVIORS OR SUICIDAL URGES Most of the students with emotional or mental difficulties are reasonable and sensible. However, some of their emotions may become so intense that they can pose potential threat to themselves or others. The following describes how to handle students with aggressive behaviors or suicidal urges. Chapter Three: Approaches in Handling Students in Distress “Most of the students with emotional or mental difficulties are reasonable and sensible.” Chapter Three: Approaches in Handling Students in Distress For Aggressive Behaviors Note: These situations are infrequent as students experiencing mental health difficulties are rarely violent. Assure the safety of yourself, others and the student. Talk to the student in a safe and comfortable place. Stay in an open area with a visible means of escape. Remain calm and adopt a non-threatening approach, while asking someone else to seek help or get help by yourself. Do not crowd the student, but explain your actions before you act and continue to assure the student without being patronizing. Do not hesitate to seek help from colleagues and the Security Office if you believe your situation is frightening and distressing. SAFE AND COMFORTABLE PLACE ASSURE THE SAFETY SEEK HELP NONTHREATENING APPROACH EXPLAIN YOUR ACTIONS
41 40 Chapter Three: Approaches in Handling Students in Distress Chapter Three: Approaches in Handling Students in Distress “Do not hesitate to seek help from colleagues, Counseling and Wellness Center and Security Office.” For Suicidal Urges Take threats of suicide seriously. Attend and listen non-judgmentally, allow the student to talk and express fully his/her feelings; and respond with empathy to let the student know that you can feel what he/she is feeling. Without giving false hopes, use appropriate silence to help you plan what to do next and give the student some time to think or experience emotions. Restrict access to lethal means, e.g., weapons or high ground. Decrease isolation by telephone contact, constant personal watch, or monitoring of activities. EMERGENCY CONTACTS If the student is in imminent danger or if you feel unsafe, immediately call: Counseling & Wellness Center for consultation 2358 6696 Security Office 2358 8999 for reporting of top emergencies on campus 24/7 HEARing Helpline exclusively for HKUST community 8208 2688 Police or Ambulance 999 for reporting of top emergencies off campus
43 42 Chapter Three: Approaches in Handling Students in Distress Chapter Three: Approaches in Handling Students in Distress Our Student Counselors are always ready to support in hospital transfer. School/Department colleagues are advised to pay hospital visits at appropriate time. The student may sometimes want to be discharged from hospital. He/She should be advised to accept and follow the psychiatrist’s decision and comply with medical instructions for complete recovery. CARE FOR HOSPITALIZATION A student who is suspected to be suffering from severe mental illnesses or with high risk of suicide is normally admitted to the Accident & Emergency Department at Tseung Kwan O Hospital in Hang Hau, the closest hospital to the University. Upon medical assessment, the student may be transferred to a psychiatric ward (usually United Christian Hospital/Kowloon Hospital) for psychiatric treatment. Before the transfer, consensus from the student and/or his/her parents is required. The student who refused the transfer may be ordered to be detained for observation if his/her mental disorder is of a nature or degree which warrants detention in a mental hospital for observation for at least a limited period and if the detention is in the interests of his/her own health or safety or with a view to the protection of other persons (Part 3 Section 31, CAP 136 Mental Health Ordinance). To secure a smooth transfer, both the student and his/her parents should be well-informed about the reason for transfer and the environment in a psychiatric ward.
45 44 Chapter Four: Diversity on HKUST Campus Chapter Four: Diversity on HKUST Campus HKUST is an international university. In the academic year of 2017-2018, approximately one-third of the total student population are non-local. Even within the same culture or nationality, each student is unique with his/her family background, socio-economic status, religion, gender, sexual orientation and physical abilities. When we interact with students in distress, we have to bear in mind their diversity, and be sensitive to their background with openness and flexibility.
47 46 Chapter Four: Diversity on HKUST Campus RESPECT AND SENSITIVITY Each student has a unique profile that affects the way he/she perceives and responds to the world as well as the way other people interact with the student. There are some situations in which a clash occurs from the difference in the cultural background or value system between a staff/professor and a student. This could create a tremendous amount of distress to the student. When we interact with students, let us be aware of our own attitude, value and cultural background that may have an influence or pressure on the student. And be sensitive about the potential distress that may come from the student’s unique profile. Students from different cultures and races may follow their traditions very seriously. Always be respectful of their tradition, and avoid making any critical or judgmental comments. Even if you believe you are familiar with a student’s cultural background, it is still important to listen to their perspectives. Refrain from making assumptions about the student or relying on stereotypes just because the student comes from a certain group. Chapter Four: Diversity on HKUST Campus “ I’m the only international student in my research group, and I was originally very excited that I could know people from other countries. But I was shattered by the differences in thinking, communication and I am unable to mix in with the other groups even though I tried very hard to. I feel very isolated and lonely. ” ~ Anonymous Student ~ SEXUAL ORIENTATION RACE CULTURE FAMILY STATUS GENDER STATUS PHYSICAL ABILITIES SOCIOECONOMIC BACKGROUND RELIGION
49 48 Chapter Four: Diversity on HKUST Campus Chapter Four: Diversity on HKUST Campus Moreover, different cultures express distress in different ways. Some disclose physical symptoms to convey emotional distress. Some accept having stress but refuse to admit having anxiety, depression or any mental health problems. When you communicate with students from different cultural background, you may use the same expression that they use to describe their distress. Gently explore with them their views on seeking counseling services if you think they need so. De-stigmatize students who need counseling services by sharing that it is common for our students to seek counseling or emotional support, and it is not a sign of weakness. STUDENTS WITH SPECIAL EDUCATIONAL NEEDS (SEN) There are a number of students who has declared SEN status to the University’s SEN Support under the Dean of Students’ Office. With proper documentation of their disabilities, such students are eligible for adjustments to facilitate their learning experience. Common SEN includes physical, visual, hearing, speech, or learning disabilities, Attention Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), psychiatric disorders, and chronic health problems. While some of the disabilities are inborn or have a chronic history, other disabling conditions can occur from accident, illness, stressful life event, trauma or injury. Some students with SEN may adjust well with their own resources and support. Some may need assistance from the University. “ I do not dare to express my different opinion to my supervisor, not to mention disclosing my difficulties to him. As this is a sign of incompetence and it’s disrespectful to express discontent to people in higher rank. ” ~ Anonymous Student ~
51 50 Learning Disabilities Students with learning disabilities have neurological impairments that interfere with information processing, memory retrieval and output. They have persistent difficulties in learning keystone academic skills including reading and spelling, writing, arithmetic calculation, and mathematical reasoning. Examples of specific learning difficulties include the following: Chapter Four: Diversity on HKUST Campus Chapter Four: Diversity on HKUST Campus Students with different SEN may need different support and adjustments. Some of their disabilities are easily noticeable and accepted by the general public, e.g., physical disabilities, while some are often misunderstood and blamed, e.g., students with ASD showing odd and repetitive behaviors in classroom. Better understanding of SEN can facilitate effective communication. If you have concerns about a SEN student, please contact the SEN Support at sen@ust.hk or (852) 2358 6696, or the Counseling and Wellness Center for advice and support. You may also visit this webpage for more information: http://sen.ust.hk Physical Disabilities Students with physical disabilities need special access arrangement to classrooms and laboratories, as well as special equipment to support their learning. Their limitation in mobility, speaking, hearing and/or vision may cause difficulties and reduce efficiency in study and learning. Chronic Health Problems Students with chronic health disorders experience difficulties participating in their academic programs due to poor physical health such as fatigue, low energy, chronic pain, or poor physical coordination. Flexibility of non-essential attendance requirements may be appropriate. DYSLEXIA Disorder of reading, writing and spelling DYSGRAPHIA Inability to write coherently, problems with accurate spelling and organizing ideas, illegible handwriting DYSCALCULIA Marked difficulty in making arithmetical calculation or computation, remembering mathematical facts and concept of time
53 52 Chapter Four: Diversity on HKUST Campus Chapter Four: Diversity on HKUST Campus Attention Deficit/Hyperactivity Disorder (ADHD) Students with Attention Deficit/Hyperactivity Disorder may experience inattentive, hyperactive and/or impulsive behaviors due to a dysfunction of the central nervous system. These behaviors may make longer class periods and time management difficult at times. Psychiatric Disorders Students with psychiatric disabilities may have a chronic and debilitating psychological condition that at times affect their abilities to participate fully in a routine educational program. Examples of psychiatric disorders include depression, anxiety disorders, bipolar disorders, early psychosis or schizophrenia, social anxiety disorder and eating disorders. The side effects of medication may also adversely affect daily functioning, attention, problem-solving, decision-making, memory processing and overall academic or social performance. Autism Spectrum Disorders (ASD) Students with Autism Spectrum Disorders may be observed to be inappropriate in social interactions, making poor eye contact, insistence on sameness and inflexible adherence to routines. They usually have difficulty in finding a team in group project, or may exhibit impulsive and repetitive behaviors when they are in distress. Typically, they are concrete thinkers and may have difficulty with vague assignments and taking another perspective. Assistance is needed to find teammates in group projects, or in interacting with fellow classmates.
55 54 Chapter Five: Supporting Students with Mental Health Difficulties Chapter Four: Diversity on HKUST Campus SENSITIVITY TO LGBTQ STUDENTS LGBTQ refers to lesbian, gay, bisexual, transgender and queer (or questioning) sexual identity or orientation. Some LGBTQ students may hide and feel reluctant to disclose themselves for fear of being rejected or bullied. Some experience considerable internal struggle and disturbance as they face obstacles, rejection, and challenges from family and society. The two factors known to be the most detrimental to their mental health are hostile school climate and family rejection. Being bullied at school or rejected at home increase the risk of suicide and is associated with increased depression, decreased self-esteem, increased substance addiction and increased school dropout (Fedewa & Ahn, 2011; Toomey, Ryan, Diaz, Card, & Russell, 2010). It would make a great difference to them if you would help to promote an understanding, embracing and supportive environment for students with different sexual orientations and identities. References Fedewa, A. L. & Ahn, S. (2011). The effects of bullying and peer victimization on sexual minority and heterosexual youth: A quantitative meta-analysis of the literature. Journal of GLBT Family Studies, 7(4), 398-418. Toomey, R. B., Ryan, C., Diaz, R., Card, N. A., & Russell, S.T. (2010). Gender nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Developmental Psychology, 46, 1580-1589. “It would make a great difference to them if you would help to promote an understanding, embracing and supportive environment for students with different sexual orientations and identities.”
57 56 Chapter Five: Supporting Students with Mental Health Difficulties Chapter Five: Supporting Students with Mental Health Difficulties “In fact, many students who encounter life challenges actually have effective coping strategies and support already in place.” As you go through this chapter, we hope to help you understand the circumstances and issues that our students are dealing with, become more empathic towards their personal experiences and struggles, and be sensitive to the signs and symptoms associated with the various types of psychological distress and concerns. We also provide suggestions on how to respond to those students where help deem necessary, as well as the available resources that you can seek for reference. SUPPORTING STUDENTS WITH MENTAL HEALTH DIFFICULTIES This chapter aims to give an overview about the challenges and struggles that our students commonly face, and the major mental health concerns that they may present when the challenges become overwhelmingly distressing. In fact, many students who encounter life challenges actually have effective coping strategies and support already in place. It should be noted that not all people who experience difficulties need or wish to seek adjustment or additional support. No particular actions may be necessary except the following: Understanding and sensitivity Acceptance and containment of individual differences Creation of a climate of care and acceptance among fellow students and staff Awareness of activities which may heighten anxiety or distress for the concerned individual
59 58 CHALLENGES AND STRUGGLES THAT STUDENTS EXPERIENCE Everyday challenges and difficulties may lead to various mental health issues among our students. The following are common ones. University Life Adjustment/Transition New students often find a lot of things to get accustomed, such as physical and social environment, academic system and evaluative measures, flexible timetable, and broadened choices of student activities. Dealing with change means dealing with stress, and students may show various degrees of emotional distress before they can really settle in. It is even harder for non-local students, who need to spend extra efforts in overcoming cultural differences and with less available family and social support. Chapter Five: Supporting Students with Mental Health Difficulties Academic Stress and Difficulties Firstly, students may find their studies and the course requirements challenging. The quantity of coursework, the frequency and format of examinations and evaluations, mismatch of interests or ability levels, ineffective study skills, and related frustrations can bring enormous pressure to the students. Secondly, the keen competition among peers, the high expectation from teachers, parents, or themselves can drive the students into the illusion that they must constantly spur themselves or should never be satisfied with themselves, causing tremendous tensions and burnouts. Thirdly, the working relationships with other peers and teachers can sometimes be tough and cause additional distress and despair, especially when there is a lack of clear communication of expectation, or discrepancies in personalities or working styles. Peer Pressure or Interpersonal Difficulties Some students have to make an extra effort in establishing social support network. In a culture that values extraversion and verbal presentation, they may find it stressful to expose themselves, and tend to skip participating in activities for fear of judgment, criticism, rejection, or embarrassment. In addition, students who live in hall may need to adjust to the many differences in routines and habits of their roommates, while students who involve in group projects and other student activities are often challenged by the process of collaboration and conflict management. “Students may find it stressful to expose themselves, and tend to skip participating in activities for fear of judgment, criticism, rejection, or embarrassment.” Chapter Five: Supporting Students with Mental Health Difficulties
61 60 Chapter Five: Supporting Students with Mental Health Difficulties Chapter Five: Supporting Students with Mental Health Difficulties Technology Impacts While our students enjoy easy access to the internet and numerous advanced tools which benefit their life and learning in many ways, there are potential issues and negative impacts that technology can have on the mental health of students. Significant time spent on the internet, gaming or social networking can exacerbate the symptoms of anxiety and depression, social isolation and loneliness, as well as diminish self-esteem for some vulnerable students. It can also turn into internet addiction that impairs the students’ academic and daily functioning. Moreover, cyberbullying and cyberstalking have increased in recent years. Receiving mean and hurtful comments, or hearing rumors spread about them can generate a deep sense of helplessness, anxiety, or depression as well as a strong sense of anger or retaliation. Love Relationships and Sex-related Concerns Love and romance are obviously popular among university students. It is a normal developmental need for this stage of life, but students can be equally distressed by being involved in a relationship and not being so. For those who are not yet in a relationship, they may be caught up in doubts about their own attractiveness or social abilities, leading to problems of self-esteem, anxiety or depression. For those who are involved in a relationship, they may also be distressed by the huge and continuous efforts needed to work out the relationship and to manage the conflicts between individuals who get close enough. Besides, premarital sex, coerced sex, unplanned pregnancy and abortion are experiences that may arise from love relationships, and can be potentially hurtful and traumatic. Family Related Problems Family functioning can have profound impacts on the lives and healthy development of our students. Parental divorce or separation can hamper student development, including self-esteem, social life, career choices, graduation rates and dating preferences. Parental discord, abusive or neglectful parenting styles can be particularly damaging to the student’s emotional and personality development. In addition, family financial stability, health statuses of family members, and the students’ roles and duties in the family can all affect the students’ capacities to engage themselves in studies and related activities, and cause significant stress in their daily experiences. “It is a normal developmental need for this stage of life, but students can be equally distressed by being involved in a relationship and not being so.”
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