May 26, 2011
If you suspect a student or scholar may be in a state of deteriorating mental health or in mental health crisis, there are several factors to keep in mind. This resource lists potential warning signs and offers action items, but is not intended to be exhaustive for every situation. In some situations an individual will benefit from professional assistance and be able to continue with courses or employment without interference of his or her daily routine. In other cases, it may be determined that the student or scholar needs a partial or full medical withdrawal, and in some serious cases, medical evacuation.
When working with international students and scholars, there are additional causes for stress to take into account. An important issue for international students/scholars is cultural adjustment (homesickness, lack of familiar network, frustration with U.S. customs and traditions). There are also various cultural views of any mental health issue, and in some cultures there is a stigma associated with them. As well, there may be additional family pressure, immigration status issues, and financial stress.
Perceptions of, and reactions to, mental crises are rooted in cultural norms. This can make it difficult to communicate with a student's family, sponsoring agency, or home institution regarding the crisis. While reacting to a mental health crisis, be aware that cultural differences will make it challenging to communicate with parties from different cultural backgrounds.
It is also very important to note that this resource is not intended to encourage international office staff to take on the role of mental health professionals. Counseling and treatment should be provided by licensed professionals only. This resource offers possible signs that there could be a mental health issue present, which is important because international office staff members are often a consistent point of contact for international students/scholars. Please consult with the mental health professional staff at your campus on all matters before becoming involved. If possible, request basic training for the staff in your office, such as suicide prevention. Basic suicide awareness/prevention training is available at most campuses. Consult with the counseling services at your institution, and if not available, consider a private practice providing the training.
Warning Signs
Some of the warning signs that indicate an international student or scholar may be in deteriorating mental health/crisis include the following:
- Noticeable change in behavior
- Change in appearance
- Sporadic communication patterns
- Declining grades
- Missing classes, work, meetings, or appointments
- Beginning to socially isolate themselves
- Bizarre behaviors
Keep in mind that cultural aspects of mental health can significantly affect the situation of whether or not the individual perceives that he/she has a mental health condition and whether or not seeking medical assistance is appropriate.
Signs That a Mental Health Crisis May Be Imminent
- Combination of any of the above warning signs
- Combination of people sharing a concern about the individual, including university faculty and staff, peers and roommates, and family members
- Physical deterioration : poor hygiene, rapid weight loss or gain, exhaustion or lethargy, hypo/hyper-activity, blurred vision, abnormal physical manifestations
- Mental deterioration: confusion, paranoia, poor academic performance, delusions, loss of reality
- Emotional deterioration: outbursts, extreme irritation or anger, uncontrollable crying, thoughts or threats of suicide, extreme stubbornness, inability to reason
- Social deterioration: isolation from friends and family, discontinued use of social media, concerning posts on social media sites, inappropriate expectations and/or interpretation of relationships, unreasonable requests, threatening communication or behavior toward others, engaging in risky or dangerous activities, substance abuse, provocative behavior, nomadic lifestyle
Action Items
Encourage the student/scholar to seek counseling services. It is helpful to have materials regarding international student adjustment and mental health to give to the student/scholar . Do not attempt to fulfill the role of counselor; this should be done by licensed professionals. If needed, offer to help make the appointment.
Assess the situation
If you feel threatened or if you feel that the student/scholar is an immediate threat to him/herself:
- Call the campus police or security.
- Call another colleague into the situation so that you are not alone.
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If you suspect the student/scholar is in danger or is missing:
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Determine your level of involvement. This will range greatly depending on your specific role and your campus system. Consult with counseling center before proceeding.
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If involved, create a case file, and include the following items:
- Print outs of the student's/scholar's records from the institution's information systems (contact info, immigration information, advising notes, class or work schedule, emergency contact information)
- Contact page (a template in which you can quickly note every individual you contact regarding the case, and notes regarding the conversations)
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Determine if the student/scholar has restricted directory information. Consider institutional polices like FERPA and HIPAA.
- FERPA provides the authority for the release of information about a student in an emergency situation—when it is "necessary to protect the health or safety of the student or other individuals" However, before giving out information about a student to friends or family, confirm with supervisors and legal affairs.
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If appropriate, seek to speak with the student/scholar yourself, either by phone or request a meeting in your office. Do not attempt to visit the student at their residence. If you are concerned about the student/scholar's safety, contact campus police department or emergency services.
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When speaking with the student/scholar, be an active listener. Be aware of warning signs as you listen to the student/scholar while noticing appearance and body language.
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Utilize resources on campus that can assume specific responsibilities of the situation. These offices not only provide services for the student/scholar directly, but often can offer you support and advice.
- Counseling and mental health center
- Student health services center
- Employee assistance program
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If appropriate, check with other points of contact to assess the student's/scholar's level of crisis.
- Consider meeting together to create a plan to support the student/scholar
- Establish "lead" contact person in the appropriate campus departments or other
- Contact the student's or scholar's academic connections
- Dean's office of the student's college, department of the employee
- Academic adviser or supervising professor
- Faculty members, teaching assistants
- Contact relevant campus units
- campus police department (to see if the student/ scholar has been involved in any incidents).
- housing staff, residence hall director, apartment coordinator
- If severe, it may be necessary to contact family members or emergency contacts
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Offer support to affected individuals (if they identify themselves)
- roommate(s)
- colleagues
- friends
- student organizations
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Gather information concerning health insurance benefits. If a student/scholar has access to additional mental health services or facilities, it's important to note. Determine if the student has medical evacuation services, and if deemed necessary, know the process.
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If student/scholar is able to continue, monitor the student's/scholar's well-being during the course of their program.
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If the student/scholar is not able to continue, assist in making plans for departure and settling affairs. If medical evacuation is necessary, work with insurance provider.
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