Students in Distress: How to Identify, Intervene, and Refer to Personal Counselling Services

In the event that there are immediate concerns about the safety of the student, or where your own safety or the safety of others is imminently threatened, call 911.

Staff and Faculty are often in an excellent position to recognize behaviour that may signal that a student is in emotional distress and may need help. Being able to recognize signs of emotional distress and being willing to acknowledge your concerns directly to the student can be an important factor in successful problem resolution for the student.

The material that follows has been prepared to help you become aware of:

  1. The signs and signals that a student may be distressed.
  2. Some things that you might do to help the student.
  3. When and how to consult with Personal Counsellors at Personal Counselling Services (PCS).
  4. How to make referrals to us.

Because of the heavy demand on our services, we typically are not able to meet with students the same day they contact us. We are aware, however, that crises requiring immediate attention can exist for students and we will meet with students who are in crisis on a same-day basis. We encourage you to read "What to do in a Crisis". Please feel free to call our office at 416-736-5297 to consult with an on-call Personal Counsellor regarding a student about whom you are concerned.

Common Signs and Signals that a Student May be in Distress

At one time or another, many individuals feel depressed or upset. However, there are indicators of student distress listed below which, when present over a period of time, suggest that the problems may be of greater concern.

1. Sudden or Drastic Changes (including but not limited to):

Behavioural Changes:

  • Decreased, disorganized performance.
  • Frequent missed classes, appointments, assignments.
  • Repeated requests for academic considerations.
  • Themes in written or creative works which reflect violence, threat, despair, hopelessness or suicidality.

Physical Changes:

  • Indications of lack of personal hygiene, ability to care for self.
  • Signs of lack of sleep, fatigue.
  • Indications of substance abuse.

Personality/Emotional Changes:

  • Change in style of interacting (e.g. becoming withdrawn or much more outgoing, angry outbursts, tearfulness).
  • Increase in level of anxiety, stress.
  • Unusual or exaggerated emotional responses.

2. Indicators of Possible Risk to Self or Others

3. Other Indicators:

  • Other people – students, staff, faculty expressing concern for the student.
  • Direct statements by the student indicating a problem in personal life.
  • Loss – through death, relationship break-up, illness.
  • Your intuition/sense that something is happening to the student.

Many students will experience/exhibit one or more of these during their university career. The presence of one of these indicators does not necessarily mean that the student is in serious difficulty. However, it is important to check it out with the student if you are concerned. The student may not immediately take you up on your offer to talk and may not be interested in a referral suggestion. However, you have signaled your interest and concern which may help the student obtain assistance if and when it is needed.


Strategies for Responding to Students in Distress

A student may reach out to you for help with personal problems or you may become concerned about a student for some of the reasons outlined above. In either case the following suggestions might make it more comfortable for you and for the student.

Do:

  • Talk with the student in person.
  • Talk in private (unless it feels unsafe to do so).
  • Stay calm and listen carefully.
  • Express your concern for the student.
  • Take the student seriously.
  • Try to understand the student’s perspective without being judgmental.
  • Be patient, allow the student to talk at the student’s own pace.
  • Determine what the student wants/needs from you.

Don't:

  • Judge or minimize the student's thoughts or feelings.
  • Ask "Why" because it can sound judgmental.
  • Be defensive or personalize what the student is saying.

Be Aware of Your Own Personal Limitations:

  • Get other people involved; if at all possible, don’t deal with a crisis by yourself.
  • Don’t take on too much responsibility.
  • Don’t make promises to the student that you may not be able to keep (e.g. maintaining confidentiality if a student is unsafe).

Note: If you would like to speak with a Personal Counsellor to help you determine what to do, or how to make a referral, please call us and ask to speak with the Personal Counsellor who is on call. If the situation is urgent, please alert our receptionist and we will take the call immediately whenever possible (416-736-5297).


How to Intervene When There Are Indicators of Suicide Risk

If you learn that a student is in the process of taking life-threatening action or is likely to do so imminently, call 911. It is probably more likely that you will encounter students who are considering suicide but who are not at the point of taking action. The following are some of the potential indicators that a student may be at risk of self-harm. (NOTE: This does not constitute a complete list. If you are uncertain about the risk of harm, consult with an on-call Personal Counsellor by calling 416-736-5297):

  • Feelings of hopelessness and a belief that things are out of control.
  • A prior attempt.
  • Direct or indirect suicidal threats.
  • A specific plan.
  • Chronic illness, fatigue.
  • Severe depression.
  • Feeling isolated.
  • Family or relationship difficulties.
  • Inconsolable grief.
  • Financial stress.
  • Alcoholism, chronic use of other drugs.
  • Family history of suicide.
  • Sudden change in behaviour, such as over-elation, sudden calm, ignoring schoolwork, giving away valued personal possessions, or poor impulse control.

If you find yourself in a position of noticing the above in a student and you want to help, the suggestions given in the previous section, Strategies for Responding to Students in Distress, are appropriate as general guidelines. When suicide is the concern, however, the best approach is to ask directly and caringly about the student’s intent. For example, you might say something like:

“Are you thinking about ending your life?”

OR

“Are things so bad for you right now that you are thinking that suicide is the only answer?”

The student hearing this will have found someone who cares and is willing to talk about this “taboo” subject. This is often a relief to the student who then may be able to begin an exploration of alternatives and to engage in some emotional release. However, it is important to convey to the student both your concern as well as the limitations of your role and to encourage the student to seek professional assistance.

Remember, whenever possible, don’t do this on your own – involve other people. You can:

  • Call 911 if there is immediate danger.
  • Bring the student to CDS if the student is willing and the situation is urgent;.
  • Call us (416-736-5297) to consult with an on-call Personal Counsellor if you would like to discuss aspects of assisting the student to get professional help.

Don’t make promises you can’t keep (e.g. promising the student that you won’t tell anyone else that the student is thinking of suicide). If a student’s life is in danger, you will want to be able to tell relevant others to get the assistance needed.


When to Refer Students

When a student is experiencing a life-threatening situation call 911.

When a student is experiencing a crisis that is not imminently life-threatening but is urgent/overwhelming, call us to consult and/or bring the student to CDS.

In other situations, where the student is distressed but is not in crisis, suggest that the student make an initial appointment with Personal Counselling Services.

Please note that we see only students who seek our help voluntarily. You can encourage the student to see us but in the end it is the student’s decision.

Additional aspects of knowing when to refer have to do with you as opposed to the student. Even when a student asks you for help with a problem and you are a kind, helpful person there are times when it is better to refer the student than to attempt to provide some or all of the help yourself. In those instances it may be better to suggest other resources or to make a referral to Personal Counselling Services. Consider calling us to consult and/or making a referral when:

  • The help needed is not your area of expertise.
  • You find yourself feeling responsible for the student.
  • You are feeling anxious or overwhelmed.
  • The responsibility you have assumed is weighing too heavily on you.
  • You are not comfortable in handling the particular situation.
  • You know the student personally (friend, neighbor, friend of a friend) and think you may not be objective enough to help.
  • The student is reluctant to discuss the situation with you.
  • You see little progress in the student and you don’t know what else you can do for the student.
  • You feel pressed for time.

How to Refer Students

Let the student know that you think he or she should get assistance from another source (i.e. other than yourself).

You may want to make a general statement such as:

“You seem to be fairly upset about this and I think that you could use some help in sorting out these issues. I am concerned about you and I would like you to consider talking to one of the Personal Counsellors in our Counselling & Disability Services.”

Be frank with the student about the limits of your time, ability, expertise and/or objectivity.

Listen to the student's concerns about seeking help. Normalize the referral process. Assure the student that many students seek help over the course of their university career. Emphasize that Personal Counselling Services are available and accessible to all currently enrolled York students with no user fees, and that a student can check us out to see if counselling is right for him/her at a given time

You can begin to establish positive and realistic expectations for counselling. It might be helpful if you read our FAQs. Help the student know what to expect if he or she follows through on the referral. Alert the student to the fact that our services are confidential (e.g., we will not even confirm for you that the student has or has not contacted us without the student’s consent) and that participation in any of our services does not get entered on the student record or transcript.

If the referral is rejected, don’t take it personally. Any given student may have a number of reasons for not seeking help – whether here or elsewhere. Readiness may be a factor, or counselling may be considered “unacceptable” by the student’s culture. Or, the student may have had a previous experience with the mental health system that was negative.

Keep the lines of communication open. If possible and appropriate indicate to the student that he or she can remain in touch with you at least until a supportive relationship has been established at Personal Counselling Services or elsewhere.

What a Student Can Expect When Referred for Personal Counselling

It is the policy of Personal Counselling Services to provide short-term individual, couple and group counselling services. Depending upon the client’s circumstances and the availability of counsellors, clients may be offered counselling with us or may be referred to an appropriate resource in the community. Longer-term therapy may be available in some situations, but ordinarily clients requesting or needing long-term treatment are referred to appropriate services off campus.

Crisis Session

If the student is in crisis and is requesting a same-day appointment, he or she will be seen by a Personal Counsellor as soon as possible – usually within 20 minutes of arrival at CDS. The student will provide us with some demographic information and will be asked to fill out a brief form indicating the nature of the crisis.

Crisis intervention services are designed to assist students who are confronting life-threatening circumstances, current or recent traumatic experiences, or acute and overwhelming emotional distress. The goals of a crisis intervention session are different than those of a non-crisis counselling session.

Goals of Crisis Intervention:

  • Containment.
  • Stabilize client and situation.
  • Immediate safety of client and/or others.
  • Plan for next steps and follow-up as needed.

Crisis Intervention is NOT:

  • Therapy
  • A substitute for ongoing therapy with a counsellor.
  • Emotional support or a way to vent feelings in the absence of immediate crisis.
  • A bridge between therapy sessions with a client’s regular counsellor. If a client truly needs more frequent contact, this should be arranged within the therapy relationship/process.
  • A way to jump the queue, by-passing the regular intake process and wait list.

During the session the counsellor will:

  • Assess the immediate situation by identifying the nature of the crisis, determining any safety concerns and identifying the client’s personal resources and social supports.
  • Establish a clear understanding about the nature of, and goals for, the crisis contact and set clear boundaries for the contact.
  • Assist the client to problem-solve around self-care, decrease immediate distress and develop a safety plan.
  • Help the client identify ways to make use of existing potential supports and to access new resources.
  • Work with the client to set up a clear plan for next steps regarding treatment and follow-up as necessary.

Non-crisis initial session

Students who are not in immediate crisis are encouraged to make an initial appointment for personal counseling. Due to the number of students seeking our service there is sometimes a one- to two-week wait for an initial appointment. During this first appointment, we assess the student’s counselling needs and determine if we will be able to provide counselling sessions at Personal Counselling Services or will need to refer the student to another mental health agency. If the student is offered counselling with us, there will sometimes be an additional wait of a few weeks before ongoing sessions can begin. While this is unfortunate and can be frustrating, it is not unusual in university counselling centres or outside the university where many community agencies have wait times of months. We attempt to see students as soon as possible for the initial appointment and then offer immediate services if the student is in unsafe or urgent circumstances.


Follow-up: What You can Expect from us after Referring a Student

Due to our policy of maintaining confidentiality for our clients, unless the client gives us consent to speak with you, we will be unable to tell you anything about our contact with the student you have referred. Due to our professional and ethical obligations, we are not able even to acknowledge whether the student actually met with us. We recognize that this can be frustrating for the referring individual (who understandably wants to know that the student referred is receiving care). However, in order for students to feel comfortable using our services, we must maintain their confidentiality in all but a few situations where we are legally and/or ethically obliged to break that confidentiality. Of course there are many instances when students want us to be able to speak with the person who referred them or to contact someone else in the York community about their situation. In such cases, the student signs a consent form authorizing us to release information and we are then able to discuss aspects of the student’s situation with a third party.