Planning to Avoid Mental Health Crises Abroad

Transcription

1 Planning to Avoid Mental Health Crises Abroad Story Time and Some Mindfulness Patrick Morgan University of Michigan Rachel Reuter University of Michigan Lex Enrico Santi Cornell University

2 SPECTRUM OF ISSUES AND A CAST OF A THOUSAND PULSES OF BRIGHT LIGHT

3 I want to get to this. FOSTERING SELF-CARE

4 I SHOULDN T SAY THIS BUT THE DIME STORE MEANS, WHAT IS THE SIMPLEST WAY TO BREAK DOWN AN ENTIRE FIELD? Don t quote me but

5 DIME STORE MSW THINGS I WANT YOU TO THINK ABOUT: What does it mean to have a behavioral issue? When does an issue rise to be truly problematic? What does it mean to be diagnosed is it important? How do we develop treatment plans and why are they important? How do we create programs that foster self-care and are not replicating unhealthy models?

6 SCENARIO #1 Student was found wandering the streets in Berlin by police. You, the program leader, have been told the student is talking in coherently and sleeping on park benches. You are on your way to see the student at the police station.

7 DIME STORE MSW CASE STUDY QUESTIONS At what point do you discuss this issue with the student What are your first steps? What resources exist at your institution? How do you gain services abroad?

8 DIME STORE MSW It only becomes an issue when: It is affecting, work, school, job, personal connection with others, relationships. Severe cases impact: finances, health, legal

9 DIME STORE MSW GOAL #1: DON T DIAGNOSE YOUR STUDENTS It is about their behavior and their work Are they going to class? Are they participating in discussions Are they doing their work?

10 WHAT DO THE STATS SAY?

11 MENTAL HEALTH ON COLLEGE CAMPUSES WHAT DOES THE DATA SAY? Anxiety: 41.6% Depression: 36.4% Relationship problems: 34.8% More detailed information available at: American Psychological Association 2013 report

12 MOST COMMON ISSUES

13 ANXIETY, DEPRESSION OH MY! ISSUES 24.5% Students are taking psychotropic medications 19% of directors of campus facilities say that the psychiatric services are inadequate. 21% of counseling students present with severe mental health concerns 40% present with mild anxiety or depression

14 SCENARIO #2 Suicidal Ideation, Forcible Withdraw and a Reluctant Student Rachel Reuter University of Michigan reuterra@umich.edu

15 INITIAL INFORMATION Program in London: 28 undergrads, 2 faculty members Day 1: June 5, 2017 It s 2 days after the London attacks, 2 weeks after the attack in Manchester Receive panicked phone call from a parent worried about how the attacks have affected her daughter (Katherine) Katherine offering mental health resources and asking if she wants to go home K does not respond Other students have left program. Katherine expresses no interest in leaving

16 QUESTIONS: Part 1 1. At this point, what are your main concerns for this student (if any)? 2. Can you legally provide any more information to the parent? 3. Do you have any follow-up steps?

17 June 6, 8:00am (EST) Faculty members say Katherine has had academic problems for weeks. She seems to be exhausted all the time, isn't used to all of the walking that the group does. They have asked her how she is doing as well. She says she is okay and leaves it at that.

18 June 12, 4:00am (EST) Receive phone call from London faculty (Leslie) who just met with Katherine K feeling depressed, anxious and suicidal Katherine leaves to work on a project; promises to meet Leslie tonight at 7pm (8 hours) Leslie shares s from K over the past week: Struggling with my mental health my anxiety and depression is really bad Don t feel comfortable attending the excursion tomorrow scared to leave my apartment The program ends in 5 days. Katherine is then supposed to spend 10 days alone in London, before traveling to rural Chile for another UM program

19 QUESTIONS: Part 2 1. What are the immediate concerns that need to be handled? What next steps will you take? 2. What are the longer-term concerns that need to be considered? 3. Who else do you involve in the situation at this point?

20 June 12, 8:00am (EST) You reach Katherine by phone She tells you that she s fine, and hasn t thought about harming herself in a few days You ask her to see a doctor or therapist on-site K declines. You ask her to meet with her professor, who is waiting for her at a café near K s apartment K says she is on a train and doesn t know when she will return; refuses to meet with her professor

21 Questions: Part 3 1. Legally, what options do you have at this point? 2. Can you force Katherine to see a professional? If yes, what do you need to take into consideration from a logistical and mental health standpoint before enacting this option? If no, what are your alternative options?

22 June 12, 11:00am (EST) OGC says it is legal to compel K to see a physician. Also OGC tells you to contact parents ASAP. Katherine agrees to mental health evaluation Katherine s parents are very concerned. They want her to return to US immediately. They have noticed a marked change in Katherine s demeanor over the past two weeks: Tone in her voice is not my daughter

23 June 13, 5:00am (EST) Katherine is two hours late to class. Did not stay at student housing last night Missed her 8pm meeting with Leslie. Was out with friends K attends appointment. After evaluating K, the doctor asks if he can speak with the professor (in K s presence); K agrees. It becomes clear that K has misrepresented serious facts to the physician, which the professor corrects. After the appointment, K wants to go for a walk and meet friends

24 Questions: Part 4 1. Do you allow Katherine to leave without the report from the physician? 2. If Katherine is deemed a risk to herself, how will you track her down again?

25 June 14, 12:00pm (EST) Report is finally returned from physician. Katherine is deemed not an immediate risk but does have mental health concerns to be addressed Admits to thoughts of self-harm and suicide; no intention to do so In Chile, students will: Live with host families that speak little English Community is more than 1 hour from nearest major medical facility, even further from nearest mental health facility Days are long and full of physical labor and emotional reflection

26 Questions: Part 5 1. What steps can you take next? Should Katherine be allowed to participate in the Chile program? 2. What about her unaccompanied stay in London?

27 Wrap-Up Katherine is not allowed to participate in Chile program Offered option to medically withdraw with no penalty Otherwise, mandatory withdraw (no credit, no refund) We can t do anything about time unaccompanied in London Ask Katherine to tell us when she plans to return to US She does not contact you again. No recourse since no longer a student on a UM program.

28 Lessons Learned? 1. Office of General Counsel was invaluable Made tough decisions quickly and without hesitation 2. Trauma effects everyone differently. Mandatory weekly check-ins with on-site staff might have revealed some of these issues earlier (currently recommended, not required) 3. On-site staff communication clearly was not up to par as many had concerns but no one shared it with UM until it had already escalated. Ask on-site staff to send weekly check-ins to home office and/or meet as a group on-site to discuss potential concerns 4. Train your staff in QPR. Faculty/on-site staff should know what to do / what to ask if a student reports feeling suicidal and or has thoughts of hurting themselves

29 Lessons Learned (Cont ) 4. Mental Health evaluation took much longer than we were told Need to have a plan for waiting period (before/after appointment) Who deems how at-risk student is while waiting for official report? 5. Is voluntary v. mandatory withdrawal an option? 6. Have a policy for the ability to take action if physical/mental health status changes in weeks leading up to program What if student has knee surgery 3 weeks before a physically grueling program but is adamant they want to participate? 7. What recourse do you have once the program has ended? Are you still responsible for the student?

30 SCENARIO #3 Suicidal Ideation: He said, She Said Patrick Morgan University of Michigan

31 ROAD FORWARD WHAT ABOUT NEXT TIME?

32 DIME STORE MSW A neuroscientist questions his faith in science and asks what other ways could support individuals with depression and anxiety.

33 FOSTERING SELF-CARE mindfulness Science is in there: - Reduces Anxiety, 13 Mass General - Decreases Bias ( 15 central Michigan) - CBT and Mindfulness can treat depression, APA - Increase Body Satisfaction controlled study. - Improves Cognition 2010 Cognition journal - Reduces distractions Harvard study

34 FOSTERING SELF-CARE Benefits of active work outs Boost happiness levels Learn to set-and achieve goals Reduce the risk of heart disease Sleep better Increase strength and flexibility Improves memory Increased self-confidence

35 FOSTERING SELF-CARE Eating healthy matters: - Heavy fats and salts impact organs and health. - Eating well can boost your immune system. - Reduces blood pressure. - Low sugar diets taper off your anxiety. - Healthy foods provide increased sustenance and boost energy.

36 FOSTERING SELF-CARE Yoga is important, Namaste: - Increased flexibility - Muscle strength and tone - Maintain your balance! - Weight reduction - Protection for injury - Increased cardio health

37 FOSTERING SELF-CARE Sleep is important, like really: - Improves memory - Live longer - Curb inflammation - Spurs creativity - Improves your ability to perform - Improves grades! - Sharpens attention - Helps with weight reduction - Lower stress - Avoids Accidents

38 DIME STORE MSW GOALS How can you identify in your program ways to foster mental health in your program? Instead of thinking about what could go wrong, think about how to make the healthiest program possible.

39 THOUGHTS?