How to Help a USF Student in Crisis

Office of the Dean of Students (ODOS)

+1.415.422.5330

Counseling and Psychological Services (CAPS)

+1.415.422.6352

Public Safety Emergency (DPS)

+1.415.422.4911

1. RECOGNIZING STUDENTS IN DISTRESS

Open Letter to USF Community

Privacy Law & FERPA 

Mental Health Trends 

USF Mental Health trends

Why do I need to know about student mental health and wellness?

2. KNOWING WHEN AND HOW TO TAKE ACTION

Indicators of Distress

What Should I do?

A Collaborative System of Support

Red Folder Report

3. SPECIAL CONSIDERATIONS

Barriers to help seeking 

Varied communication styles

Working with international students 

Intersectionality

Students with Disabilities

Student Veterans/Active ROTC/Reserves

LGBTQ-Identified Students

4. RESPONDING TO DISTRESSED & DISTRESSING STUDENTS

Anxiety

Depression 

Suicide 

Grief & Loss

Disordered Eating 

Poor Contact with Reality

Responding to Emotionally Distressed Students

Trauma & Abuse

Sexual Assault/Abuse

Abusive Relationships

Stalking/Harassment 

Hate Crimes

Hazing

Responding to Reports of Trauma and Abuse

General Health & Wellness Distress

Academic Difficulties

Financial Difficulties

Adjustment/Transitions

Substance Abuse

Self-Injury

Responding to General Health & Wellness Distress

Distressing & Disruptive Students

Excessively Demanding/ Dependent Student

Aggressive/Potentially Violent Student

Responding to a Distressing Student

5. WHAT CAN FACULTY AND STAFF DO TO REDUCE STRESS

Am I Causing Undue Stress?

Get to Know Your Students

Fostering Cooperation vs. Competition

Being Clear in Expectations and Communication

Evaluate students without causing undue stress 

Focus on Strength

Responding to a student mental health and wellness situation: A quick decision tree for faculty-staff action

Open Letter to USF Community 

Dear USF Community, 

Has this ever happened to you? 

• A student comes to your office or class and is obviously impaired and disruptive? 

• A student reveals to you that they are having thoughts of suicide? 

• A student, who is usually well-prepared, begins to miss class or meetings, fails to complete assignments and misses deadlines, and becomes inattentive to hygiene and personal appearance? 

• A student reveals that they were sexually assaulted, or is being stalked, or bullied? 

• You learn a student is suffering discrimination and/or hostile treatment because of their sexual identity/gender identity? 

The Promoting Student Mental Health and Wellness Guide was created to better equip the community to support students. We encourage you to reference this guide when seeking resources on and off campus. 

Privacy Laws & FERPA (Family Educational Rights and Privacy Act)

You may have some concerns about disclosing student information. Please review the following frequently asked questions regarding privacy laws.

✵ Can information from a student’s education records be disclosed to protect health or safety?

FERPA permits the disclosure of information from student education records ... in connection with an emergency if knowledge of the information is necessary to protect the health or safety of the student or other individuals.

✵ What can I say if a parent calls me?

FERPA and other student privacy regulations generally allow the university to release information to parents, police or others whose knowledge of the information is necessary to protect the health and safety of the student or other individuals. In addition FERPA does not prohibit disclosure of personal knowledge or impressions about the student that are not contained in student records. 

If you are unsure if disclosure is necessary to protect the health and safety of the student, seek consultation from your direct supervisor, ODOS, or campus counsel. You can always listen to a parent's concerns and let them know you will get back to them after you get clarity on what information you can release. FERPA does not prohibit you from gathering information from outside sources. 

✵ For more information about FERPA: 

http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html 

National Mental Health Trends 

The Centers for Disease Control and Prevention (CDC) reports that: 3.9% of adults aged 18 and older have experienced serious psychological distress in the past 30 days. A recent report from Mental Health America, a nonprofit founded in 1909 that’s dedicated to addressing the needs of people living with mental illness and promoting good mental health in America, offers some statistics pertaining to the current state of mental health in America. According to its 2019 State of Mental Health in America report: 

Over 44 million American adults (18.07%), have a mental health condition. That actually represents a slight decrease from the 2015 report, which found 18.19% of adults had a mental health condition. The rate of youth experiencing a mental health issue continued rising, and 62% of teens and children with a major depressive episode received no treatment. (U.S. News, 2019). 

College student mental health—and how campuses are responding—is increasingly in the national spotlight. Headlines in newspapers across the country are reporting that a mental health crisis exists at U.S. colleges and universities, and that it is worsening. Campuses and their counseling centers are seeing increased, unmet demand from students. National assessment data show rising levels of anxiety, depression, and suicidality— suicidal ideation, suicide plans, and suicide attempts—among the college population. In fact, suicide is the second leading cause of death among college students.

Over half of presidents at private nonprofit four- year institutions indicated that student mental health is mentioned specifically in their strategic plan—much higher than presidents who lead public institutions (Higher Education Today, 2019). 

USF Student Mental Health Trends

[To be updated Summer 2023]

Why do I need to learn about student mental health? 

Student mental health issues affect all aspects of our academic communities.  Stress is a fact of life for students who are not just juggling rigorous academic demands; they are also coping with developmental challenges such as new friendships and relationships, new personal responsibilities, a new culture, and distance from home and family. While many students thrive when faced with these challenges, some feel overwhelmed, anxious, isolated or hopeless. 

Additionally, many of our students will be required to cope with grief and loss, trauma and abuse, major injuries, COVID-19, illnesses and psychological disorders while attending USF. The combination of all of these stressors can easily disrupt academic performance and may lead to dysfunctional coping and other serious consequences. 

Psychological problems — even more serious concerns — have high rates of recovery if appropriate help is received in a timely manner. 

Knowing the early indicators of distress, how to respond in these situations and how to contribute to a healthy learning environment will greatly increase your ability to act appropriately in such situations, help improve another's quality of life, and may even help save a life. 

Knowing When & How to Take Action 

Indicators of Distress 

Academic Indicators

• Repeated absences from class, section, lab or employment 
• Missed assignments, exams or appointments 
• Deterioration in quality or quantity of work 
• Extreme disorganization or erratic performance 
• Written or artistic expression of unusual violence, morbidity, social isolation, despair or confusion; essays or papers that focus on suicide or death 
• Continual seeking of special provisions (extensions on papers or deadlines, make-up exams) 
• Patterns of perfectionism: e.g., can't accept themselves if they don't get an A+ 
• Overblown or disproportionate response to grades or other evaluations 

Behavioral and Emotional Indicators

• Direct statements indicating: 
• General distress  
• Family conflict
• Grief and Loss
• Economic Hardships
• Angry or hostile outbursts, yelling, or aggressive comments 
• Unusual withdrawal or animated behavior 
• Expressions of hopelessness or worthlessness; crying or tearfulness 
• Expressions of severe anxiety or irritability 
• Excessively demanding or dependent behavior 
• Lack of response to outreach from course staff 
• Shakiness, tremors, fidgeting or pacing 

Physical Indicators

• Deterioration in physical appearance or personal hygiene 
• Excessive fatigue, exhaustion; falling asleep in class repeatedly 
• Visible changes in weight; statements about change in appetite or sleep 
• Noticeable cuts, bruises or burns 
• Frequent or chronic illness 
• Disorganized speech, rapid or slurred speech, confusion 
• Unusual inability to make eye contact 
• Coming to class bleary-eyed or smelling of alcohol or other substances 

Other Factors

• Concern about a student by their peers, roommates, or faculty/staff 
• A gut-level reaction that something is wrong 

Safety Risk Indicators

• Written or verbal statements that mention despair, suicide or death 
• Severe hopelessness, depression, isolation and withdrawal 
• Statements to the effect that the student is "going away for a long time" 
• Physical or verbal aggression that is directed at self, others, animals or property 
• The student is unresponsive to the external environment; he or she is incoherent or passed out 
• The student is disconnected from reality/exhibiting psychosis 
• The student is displaying unmitigated disruptive behavior 
• The situation feels threatening or dangerous to you 

Alert: 

If a student is exhibiting any of these signs, they may pose an immediate danger to her/himself. In these cases, you should do the following: 

1. If the student is in imminent danger or if you feel unsafe, immediately call Public Safety or 911. Our Public Safety are trained crisis responders. 

2. Contact CAPS at 415-422-6352 for immediate consultation. Use the CAPS All Hours option for evening or weekend concerns. (855-531-0761) 

What should I do?

Consult with these resources when you have concerns about a USF student's well-being:

1. Always contact ODOS (415-422-5330)  or CAPS (415-422-6352)  or, preferably--BOTH
2. Others you may want to contact:

• YOUR immediate supervisor 
• YOUR department chair or dean 
• Student’s faculty advisor 
• A coworker 
• CASA 
• Student’s school or college
• The Crisis Management and Behavioral Intervention Team (CMBIT) 

It is possible that you might learn through consultation that a student's concerns are already being addressed by another entity. 

How to Approach and Talk to Concerned Students 

Speak directly with the student and remember that you will NOT be taking on the role of counselor. You need to listen  and offer resource referral information. 

• Recommendations: Meet privately with the student (choose a time and place where you will not be interrupted). Private virtual options may be best at this time.
• Set a positive tone. Express your concern and caring. Point out specific signs you've observed. "I've noticed lately that you ... " 
• Ask, "How are things going for you?" Listen attentively to the student's response and encourage them to talk. "Tell me more about that." 
• Allow the student time to tell their story. Allow silences in the conversation. Don't give up if the student is slow to talk. 
• Restate what you have heard as well as your concern and caring. Ask the student what they think would help. "What do you need to do to get back on a healthy path?" 
• Suggest resources and referrals. Share any information you have about the particular resource you are suggesting and the potential benefit to the student. "I know the folks in that office and they are really good at helping students.”
• Provide name, phone number, and office location of the referral resource or, if comfortable, offer to walk with the student to the location. (Note that during the COVID-19 pandemic, some departments may be operating partially or fully remotely--it may help to call before walking a student there.)
• Avoid making sweeping promises of confidentiality, particularly if the student presents a safety risk to themselves or others. Students who are suicidal need swift professional intervention and may not be given complete confidentiality.
• Unless the student is suicidal or may be a danger to others, the ultimate decision to access resources is with the student. If the student says, "I'll think about it," when you offer referral information, it is okay. 
• Let the student know that you are interested in hearing how they are doing in a day or two.
• Document your interaction.

Question, Persuade, Refer (QPR) 

For comprehensive training in this suicide prevention approach,  please contact the Human Resources Wellness Coordinator or CAPS. Training is scheduled throughout the year.

Report

Contact the Dean of Students (415-422-5330) or CAPS (415-422-6352/-6351) to report a concern about  student. They can help you determine who else may need to be notified of the situation and/or coach you through making a referral to a student. 

Please be aware of the following: 

• Information shared with a therapist (e.g., CAPS staff, All Hours line therapists) is confidential. The therapist will accept all information you provide but may not be able to share the results of follow-up without the student’s written permission; it is necessary to protect the students' privacy. 
• It is common that the therapist you speak with may need to phone you back to provide recommendations. If the student of concern is an active client at CAPS, the therapist may need to confer with the student's treating therapist. 
• In the rare event that a therapist determines that a mental health professional will make a cold contact with the student, consider giving permission to use your name as the referral source. 

Knowing When & How to Take Action 

USF has a collaborative system of support.
 

Crisis Management and Behavioral Intervention Team (CMBIT)

This interdisciplinary team serves to proactively identify, assess, and offer a coordinated institutional response to community members who pose a risk or disruption to themselves, others and/or the campus community. CMBIT meets weekly and contributes to USF’s  and is composed of professional staff from: CASA, CAPS, DPS, ISSS, OSCRR, DOS, SDS,  and SHaRE. Whenever an assessed risk will benefit from proactive intervention or requires response, CMBIT is activated to develop and/or implement procedures to mitigate risks. 

Care Referral Program (Formerly "Red Folder")

The Office of the Dean of Students' Care Referral Program website (which replaces the prior "Red Folder") provides faculty/staff with referral information for students who are “demonstrating concerning behavior.”  The Red Folder Program is a way to refer YOUR concern about a student to the Office of the Dean of Students in an online format.  Each referral is reviewed and assessed in order to best support the student.  Any concern for any student is welcome.  

Special considerations

Some students are hesitant and/or reluctant to seek out therapy or any form of mental health treatment on their own. Although the stigma regarding mental health appears to be decreasing, as more and more students of varied backgrounds are presenting to CAPS, stigma still exists. 

As faculty and staff, you are in an influential position of being able to suggest therapy as an option for students who may not otherwise seek it out on their own.

Barriers to Help-Seeking

You are being asked to approach students from different backgrounds with sensitivity, an open mind, and flexibility. It is vital to have an understanding of some of the potential reservations and concerns students may have about therapy. Consider the following:

• Some students may consider attending therapy as a personal weakness. Other hesitations about attending therapy may have to do with a student's family members not supporting treatment or not seeing mental health issues as "real."  
• The ways in which distress is expressed can vary among cultures. For example, members of some cultural groups more easily disclose physical symptoms as a way to explain emotional distress.

Never assume that you know which barriers a student is facing. Question if they know anyone who attends therapy and if they think it could help them. Use your own knowledge and experience to make a recommendation.

Varied Communication Styles

Communication styles can differ among groups. These differences may center on personal space, volume, tone, eye contact, direct vs. indirect communication, assertiveness, expectations of authority figures, and others. 

It is important to listen for a student’s cultural perspective. Do not assume that two students from the same background will think or act alike. It is important not to make assumptions.

International Students

International students sometimes have difficulties seeking mental health assistance because of the norms of their countries of origin. When interacting with international students, please be mindful this might be the first time they are living and studying abroad. It might be difficult for them to ask for help or recognize that they need help. 

University procedures can be hard to navigate, and students from other countries may not understand how roles are divided up between different offices or feel comfortable making these connections on their own. 

Making that first phone call for the student (with their consent) or writing the steps down for them to follow can help them connect to the assistance they need. 

Additionally, CAPS offers some of our services in languages other than English, which is a useful resource.

Intersectionality

Intersectionality is the study of the relationships among multiple identities that exist within the same person. More specifically, the theory of intersectionality suggests that various biological, social, and cultural categories such as gender, race, class, ability, sexual orientation and other dimensions of identity interact on multiple and often simultaneous levels.

Students with mental health challenges will not experience those challenges in a vacuum. More often than not, they will experience mental health challenges along with the intersection of their multiple identities, which may include the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap, or intersect, especially in the experiences of marginalized individuals or groups (e.g., Filipino, gay, male, able-bodied, Catholic student with depression).

As noted, some students feel hesitant or resistant to seek out therapy or any form of mental health treatment on their own. As faculty and staff, you are in an influential position of being able to suggest mental health services as an option for students who may not otherwise seek this out on their own. 

Students with Disabilities 

Important facts about students with disabilities:

• Students with documentation of a disability are eligible to access accommodations through SDS. Common disabilities at the college level include physical, learning, psychiatric, autism spectrum, ADHD and chronic health disabilities. Disabling conditions may occur at any point in time due to accidents, illness, stressful life events, trauma or injury. 
• Students with chronic health disorders may experience difficulties participating in their academic programs due to the condition itself or the ongoing treatment protocol. Flexibility of non-essential attendance requirements may be appropriate. 
• Students with learning disabilities have neurological impairments that interfere with information processing, memory and retrieval, and output. These disabilities can have an impact on reading, writing, math, attention, concentration and/or overall organization. Students may need to use technology or other strategies to compensate. 
• Students with psychiatric disabilities may have a chronic and debilitating psychological condition that may at times affect their ability to participate fully in a routine educational program. Side effects of medication may cause delays in processing. Conditions that fall under this classification include Bipolar Disorder, Major Depression, Anxiety Disorders, and Post-Traumatic Stress Disorder (PTSD). 
• Students with Attention Deficit/Hyperactivity Disorder (ADHD) 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. 
• Students with Autism Spectrum disorders may have difficulty negotiating social situations, group work or making eye contact, or may exhibit impulsive behaviors. Typically, students with Autism Spectrum disorders  are concrete thinkers and may have difficulty with vague assignments and taking another perspective. 
• Students with disabilities may not realize that they have a particular challenge and that treatment/accommodations are available. If you have concerns about a student, please contact Student Disability Services (SDS). 

Other things to know: 

• SDS is authorized to determine appropriate accommodations for students with disabilities, which are reflected in a Faculty Notification Letter. Faculty members are responsible for providing the accommodations indicated in the Faculty Notification Letter.  
• Be open to follow-up consultation with SDS regarding accommodations for the student. Recognize that all students must be held to the same Student Code of Conduct and use SDS as a resource if you have questions or concerns about a student's behavior.
• Remember students requesting accommodations must present an accommodations letter from SDS with approved accommodations listed. Professors may not ask to see the documentation that was initially presented to SDS, but may request to see the accommodation letter. 
• Students, regardless of disability, were admitted under the same admissions requirements as their peers, and therefore need to be held to the same academic standards. Professors are not required to make accommodations that would fundamentally alter their classes.
• Take steps to develop a course curriculum that meets universal design and access standards. This includes utilizing multiple teaching styles. 
• Direct concerns about the use or presence of a service animal to SDS. 

What to avoid:

• Assuming that these students will be distressed or distressing 
• Asking questions about the disability or how the student became disabled 
• Prejudging a student's potential based on a disability 
• Making reference to the student's disability in class or in front of others 
• Using patronizing language with the student 
• Under-estimating or questioning the validity of the stated disability 
• Assuming that the limitations/accommodations for one student with a particular disability will be the same as another student with the same or similar disability 
• Assuming the student understands the academic limitations potentially imposed by the disability 
• Assuming the student qualifies for accommodations without SDS  verification 

Student Veterans/Active ROTC/Reserves 

Each year, students enroll at USF after serving in the armed forces. Some of these students have completed their military obligations, and others are still involved with the military  whether they continue on active duty or are involved with the Reserves or National Guard. Some students are forthcoming about their veteran status and experiences, while others choose not to reveal their status because they believe they may be treated differently or stigmatized by political issues associated with their military service. Consultation is available with a Veterans Administration (VA) representative. These consultations are available to USF students and provide resources, referrals, help with health care enrollment, and assistance obtaining a VA ID card. For additional information, please contact CAPS at 415-422-6352 or ODOS at 415.422.5330.

Things to know:

• Students with veteran status often have complex issues related to their academic and financial relationships with the university due to federal policies. 
• The university works with veteran students to make their transitions as seamless as possible, but federal policies often make this quite difficult. 
• Students who are still involved with the military may be redeployed so they may have difficulty fulfilling their course requirements. The university's policy is to do whatever is in the student's best interest so as to allow them to complete their courses. 

Potential obstacles to success:

Like any student, veteran students may encounter obstacles to their academic success. These may include: 

• The distraction of potential redeployment 
• Insensitivity to the experiences student veterans have had 

It is also not unusual for student veterans to be reluctant to seek any help due to the perception that they need to be strongly self-reliant.

LGBTQ-Identified Students 

The most recent USF Campus Climate Survey ( 2018) indicates that approximately 22.4% of our undergrads and 17.6% of grads identify as LGBQ, This does not include Transgender students, as that data is under the category of gender.  A 2016 survey of more than 33,000 students by the American College Health Association found that 10% identified as gay, lesbian, bisexual, trans, asexual, pansexual, or questioning. 

USF continues to take steps to create environments and policies that meet the needs of students with a wide range of gender identities and sexual orientations. These populations have historically been underserved so many college administrators are spearheading efforts to raise awareness of Lesbian Gay Bisexual Transgender and Queer (LGBTQ) identities.

The two factors known to be most detrimental to LGBTQ student mental health are hostile school climate and family rejection.

Experiences of significantly higher levels of violence in school, bullying and sexual violence, leads to higher risks for suicide, depression, substance use, and poor academic performance than their heterosexual peers. (Youth Risk Behavior Survey, 2017)  

Protective factors at USF include:

• Focused services provided through the Cultural Centers
• LGBTQ-inclusive policies and social groups
• Gender Inclusive housing and bathrooms

Distressed and distressing students may share similar symptoms. They include:

• Anxiety 
• Depression 
• Suicide 
• Grief & Loss 
• Disordered Eating 
• Poor Contact with Reality 

Anxiety:

Stress, worry and anxiety are normal, expected and inevitable parts of college life. In fact, 61.9% of clinical appointments at CAPS in 2019 reported experiencing anxiety. The areas that engendered the most stress included grades, school work, money and relationships. 

Anxiety disorders are distinguished from normal, everyday stress when the feeling is more intense, lasts longer (may persist for months instead of going away after a stressful situation has passed) and lead to avoidance behaviors that interfere with one's life. 

Anxiety can be generalized across many different situations, or situation- specific, such as test anxiety, social anxiety, specific phobia or public speaking anxiety. For some students, the cause of the anxiety is clear, and for others, it is less apparent. 

Signs and symptoms:

• Talk about being under a lot of pressure, feeling tense, stressed, burned out or overwhelmed. 
• Panic attack in which symptoms include intense fear accompanied by subsequent physical symptoms such as a pounding heartbeat, sweating, shaking, shortness of breath, chest pain, dizziness and fear of dying or losing control. 
• Feeling on edge, difficulty concentrating, trouble falling or staying asleep, headaches, restlessness, muscle tension or soreness, trembling, twitching and fatigue. 

Depression:

While almost everyone has had periods in their lives when they have felt sad or down, these feelings tend to become less intense with the passage of time. Clinical depression occurs when feelings of extreme sadness or despair last for at least two weeks and interfere with the ability to function in different areas--- school, work and/or relationships. 

Depression can affect one's ability to do simple day-to-day activities. Depression has been shown to be highly treatable with appropriate intervention. 

Signs and symptoms:

• Feelings of emptiness, hopelessness, helplessness and worthlessness 
• A deep sense of sadness 
• Lack of energy, fatigue 
• Social withdrawal 
• Loss of interest in activities one enjoyed
• Inability to experience pleasure 
• Loss of appetite or eating too much 
• Problems falling asleep, staying asleep or sleeping too much 
• Difficulties with concentration, memory and decision-making 
• Aches, pains, headaches, cramps or digestive problems that do not go away 
• Thoughts of suicide or suicide attempts 
• Irritation, anxiety 

 If you are concerned about immediate threats to safety, call 911 or contact Public Safety at 415-422-4911. 

Suicide:

Suicide is the second leading cause of death among college students. 

People who are suicidal often suffer from untreated depression and/or substance abuse disorders, which are both treatable with counseling and/or medication.

Most people who are suicidal communicate this with others directly, e.g., “I’m going to kill myself,” or indirectly, e.g., “I won’t be bothering you much longer.” People who contemplate suicide are often ambivalent about ending their lives and are willing to accept help when a caring person intervenes. It is essential that you take all suicidal comments seriously and ask the individual if they are thinking of hurting or killing themselves. Asking them if they are suicidal will not "put the thought into their head."    

How to respond:

The best referral involves taking the person directly to someone who can help. 

• USF students in crisis can be seen for same day crisis assessments, in-person or remotely, depending on the needs and/or location of the student at the time of crisis. Call CAPS to schedule a same-day crisis assessment by calling 415-422-6352.
• If a student refuses help and you are still concerned, call ODOS (415-422-5330) for consultation, provide the 24/7 CAPS All-Hours phone number (855-531-0761), and refer them to the National Suicide Prevention Lifeline 1-800-273-TALK and crisis text line (text BAY to 741741).  
• If you are concerned about immediate threats to safety, call 911 if the student is off campus or Public Safety (415-422-2911) if the student is on campus. 

Grief & Loss:

Grief is a normal response to the sorrow and confusion that can come from losing someone or something important to you. Grief is a typical reaction to death, divorce, job loss, a move away from family and friends, or loss of good health due to illness. Research shows that a student's GPA significantly decreases during the semester of loss, providing empirical support for the assertion that bereaved students are at risk for declined academic performance (Servaty-Seib, 2006). 

Signs and symptoms:

• Feel empty and numb; in shock. 
• Trembling, nausea, trouble breathing, dry mouth, or trouble sleeping and eating
• Anger at a situation, a particular person or just angry in general. 
• Guilt expressed as "I could have, I should have and I wish I would have" statements. 
• Dreams /nightmares, absent-minded, withdrawn, or lack the desire to return to class or work. 

Grief lasts as long as it takes for the student to accept and learn to live with their loss. The length of time spent grieving is different for each person. There are many reasons for the differences, including personality, health, coping style, culture, family background and life experiences.The time spent grieving also depends on the relationship with the person lost and how prepared one was for the loss. 

If a student expresses trouble making progress on their grief, a referral to the CAPS and/or University Ministry may be appropriate. Another valuable resource is  The National Students of AMF Support Network .

Disordered Eating:

Eating disorders and disordered eating are concerns on college campuses. It is estimated that more than 5 million Americans suffer from an eating disorder and even more from disordered eating patterns and body image concerns. While the majority of people with eating disorders are female, eating disorders can also affect men. Adolescent and college-age students are particularly vulnerable to these problems.

The reported suicide mortality rate among people with eating disorders is said to be 23 times higher than that of the general population, placing the rate of suicide among ED patients among the highest of all psychiatric disorders (Holm-Denoma et al, 2008; Kaye, 2008; Keel et al., 2003).

Signs and symptoms:

• Significant decrease or increase in weight 
• Dressing in layers or wearing bulky clothing to hide weight loss 
• Distorted body image 
• Preoccupation with food and weight loss 
• Regimented/unusual eating habits or secretive eating 
• Food restriction, bingeing or purging behaviors 
• Excessive exercise 
• Social withdrawal (e.g., friends, family) 
• Low self-esteem 
• Perfectionism 
• Difficulty concentrating 
• Fatigue 
• Moodiness and/or irritability 
• Anxiety and/or compulsive behavior 

Resources: 

• National Eating Disorders Association 
• National Association of Anorexia Nervosa and Associated Disorders (ANAD) 

Poor Contact with Reality

It can be especially challenging when dealing with a student who seems to have poor contact with reality. A key characteristic of these students is that they exhibit thoughts or behaviors that are bizarre and seem to be out of touch with what is occurring around them. 

Signs and symptoms:

• Odd or peculiar beliefs that involve a misinterpretation of reality. 
• Hearing voices, belief that these voices are talking to them. 
• Seeing things that are not there. 
• Talking or laughing to themselves. 
• Disorganized speech,writing or behavior (e.g.,  jump from one topic to another with no apparent connection). 
• Failure to exhibit any emotion or displaying inappropriate emotion (e.g., laughing in class when talking about a serious topic). 

The above symptoms may be indicative of a serious psychological or medical disorder. It is essential when encountering a student who displays these symptoms to call and consult with a CAPS clinician or ODOS.  Often these students may not see anything problematic with their thoughts or actions, and they may not feel a referral is necessary. 

A student who exhibits these symptoms may elicit concern and possible fear from those who have interactions with them.

Responding to Emotionally Distressed Students

Now that you have learned about the signs and symptoms of various types of emotional distress, you may be wondering how you can best be of service? Faculty and staff often ask, "What should I say? What should I do?  Consider the following strategies.

What you can do:

• Speak to the student privately. 
• Model calm behavior
• Focus on specific behaviors and/or changes you've observed. 
• Listen carefully and validate the student's feelings and experiences. (“It must be very difficult, tiring, and distressing to feel this ____ so often.”) 
• Recommend that the student consult with a counselor about their symptoms. 
• Be prepared for the student to deny any problem and to reject your help. Follow up with the student. If the student was not receptive to the referral initially, they may be upon follow-up. 
• If helpful, encourage the student to call and schedule an appointment with CAPS or ODOS while they are in your office. However, if the student is highly impaired it may be best to contact Public Safety and have them escort the student to an Emergency Room. 

Be willing to consider flexible arrangements (e.g., extension on a paper or exam), if appropriate, as a way to alleviate stress and instill hope. 

For Suicide-related Concerns: 

Take the student's comments as a cry for help. It is important that all statements about suicide are taken seriously, and not minimized. 

Project a calm demeanor, although this is not how you may be feeling on the inside. The modeling of calm behavior is very important for the student, as they are looking to you for assistance. 

Be straightforward and know that a question is not going to cause them to act on their suicidal thoughts. In fact, suicidal students usually want to communicate their feelings. Possible ways to phrase a question include:

• “I can see that this is a difficult time for you and you are feeling very distressed right now. Are you having thoughts of hurting yourself?”
• “I am concerned for you. Have you been thinking of ending your life?”
•  “Are you considering suicide?”

Question, Persuade, Refer (QPR) Gatekeeper Certification Training 

Learn to address suicidal behaviors by: 

1. Describe the Problem and Its Context. 
2. Choose Long-Term Goals. 
3. Identify Key Risk and Protective Factors. 
4. Select or Develop Interventions. 
5. Plan the Evaluation. 
6. Implement, Evaluate, and Improve. 

Training takes 1.5–2 hours to complete. Up to 35 participants can attend per session and certification lasts for three years. For a training schedule, which occurs several times a year, contact CAPS or Human Resources. 

Refer students to CAPS. 

It may be beneficial to walk the student over to the center. It is important to make sure that they actually get help, and not to assume they will follow through on their own. 

If it is after business hours and the student is in imminent danger, call 911 or contact the Public Safety for assistance. 

What to avoid:

• Minimizing the student's concerns ("But you normally seem so happy." "Your grades are so good.”)
• Overwhelming the student with suggestions of how to deal with their concern, or providing too much information for the student to process. 
• Assuming the family knows about the student's symptoms, or that the student has a family or a network of supporters. 
• Taking responsibility for the student's emotional condition. Know your limitations and utilize your support system. 

Referrals: 

• Crisis Text Line Text 741741 
• The Jed Foundation 
• Half of Us Campaign 
• ULifeline 
• NAMI Student Mental Health 
• National Suicide Prevention Lifeline 24-hour crisis line 1-800-273-TALK (8255) 

Trauma & Abuse

Some students may experience distress after abuse or trauma. Without proper support, survivors can develop post-traumatic stress disorder (PTSD), Acute Stress Disorder, Adjustment Disorder, or other anxiety related conditions. At the end of this section, you will find general tips for responding if you become aware that a student has suffered a traumatic experience. 

Sexual Assault/Abuse

One in four or five college women will be survivors of a sexual assault during their time in college. Approximately 90 percent of sexual assault survivors are female. While most sexual assaults are committed by men against women, men are also assaulted by women, and same-sex and transgender assaults also occur. The majority of sexual assaults are committed by someone known to the survivor (e.g., an acquaintance, date, partner or former partner, or family member) and most of these assaults go unreported. 

Sexual assault is generally defined as any sexual contact or activity that is forced or non-consensual. It can include non-consensual touching; threat of sexual assault; forced oral, anal or vaginal penetration; and penetration with a foreign object. Forced and non-consensual includes a person's inability to give consent because of threat of harm, coercion and/or physical violence; due to being under the influence of alcohol or drugs, unconscious, or asleep; or due to mental, developmental or physical disability. 

There are many factors that affect and/or influence a survivor's reaction to sexual assault including: the type of assault, whether the perpetrator was known or not, previous history of trauma and the reactions of others. There is no "normal" reaction to a sexual assault. There can be a wide range of individual reactions to such a trauma; however, many survivors exhibit some universal common responses.  

Title IX

The Title IX office continually strives to maintain and strengthen a climate which fosters civility, mutual respect, and inclusivity for all community members. Our primary concern is your safety and well-being and we are tasked with following up on all reports of sexual misconduct experienced by our community members. 

To report potential Title IX violations, please email or call the Title IX Coordinator at (415) 422-4563 or make a report online. 

Sexual assault and rape are terms that are often used interchangeably to describe non-consensual sexual contact. For purposes of this section of the manual, the term sexual assault is used. 

Common responses:

• Shock, confusion, disbelief or denial 
• Disruptions in routines of daily life (e.g., sleeping, eating, working) 
• Recurring thoughts (e.g., unwanted memories, flashbacks, nightmares) 
• Concerns for personal safety (e.g., fear, sense of powerlessness, loss of control) 
• Self-blame, guilt and/or shame (e.g., I shouldn't have ... , It wouldn't have happened if …)
• Intense feelings and emotions (e.g., anger, sadness, irritability, feelings of hopelessness) 
• Reduced ability to express emotions (e.g., numbing, detachment, apathy) 
• Relationship difficulties (e.g., social withdrawal, difficulty with trust, avoidance of intimacy, loss of interest in sex) 
• Academic or work problems (e.g., difficulty concentrating, impaired memory, lack of motivation, missing class, not completing assignments) 
• Increased alcohol/substance use 
• Psychological disorders (e.g., Major Depressive Disorder, Post-traumatic Stress Disorder) 

Resources:

• Abuse, Rape & Domestic Violence Aid & Resource Collection 
• U.S. Department of Justice Office on Violence Against Women 
• California Coalition Against Sexual Assault 
• Men Can Stop Rape 
• The National Alliance to End Sexual Violence 

Abusive Relationships 

Abusive relationships are marked by strategies used by one person to maintain power and control over the other. Victims may feel trapped and fearful of their partner's anger, violence and/or abandonment, and may be reticent to disclose information about their relationship. Abuse can be physical, emotional or verbal. 

Indicators of abuse:

• Intimidation: Use of looks, actions or gestures, such as smashing things, destroying property, abusing pets or displaying weapons so as to cause fear. 
• Emotional Abuse: Use of put-downs, name-calling, "mind-games," humiliation or guilt in an effort to erode self-esteem of partner. 
• Isolation: Controlling social interaction, movement and involvement with friends and activities. 
• Minimizing, Denying and Blaming: Making light of the abuse or not taking it seriously. Shifting blame for the abuse onto the victim; saying the victim "caused the abuse."
• Violation of Privacy: Abusive partners may read notes, emails or text messages from others. Abuser may go through personal belongings. 
• Using Privilege: Partners may use privilege to make decisions on behalf of the other person including attempts to control aspects of academic life, requiring permission for important decisions, etc. 
• Coercion and Threats: Making or carrying out threats to do something to hurt the partner, including leaving, threatening suicide, reporting partner to authorities regarding some behavioral or academic violation, or making partner engage in illegal activity. 

Resources:

• Abuse, Rape & Domestic Violence Aid & Resource Collection 
• U.S. Department of Justice Office on Violence Against Women 

Stalking/ Harassment

Stalking is defined as the repeated following or harassment of an individual in the attempt to instill a sense of fear or danger. Stalkers often have an irrational obsession with the victim and try to gain power through control and intimidation. Stalkers can be male or female and targets can be of the same or opposite sex. 

Behaviors may include following the person (with or without the person knowing), making inappropriate phone calls, obsessively communicating either directly or through friends of the victim, and communicating with increasing frequency and intensity. In some cases, the behaviors can include threats and intimidation. In many cases, the behavior is just annoying but other times it can be frightening (a person suddenly appears on the sidewalk outside the victim’s home). 

California has enacted anti-stalking laws to stop this type of harassment. It is not possible to determine which cases will end quickly and which cases of intrusive contact will continue for a long time. Regardless, the victim of this intrusive attention can often become distracted, anxious, tense, sensitive and jumpy.  How a survivor presents will depend upon their own unique situation, strengths and resources. 

Potential indicators:  

• Fear of a partner, acquaintance or strangers 
• Sadness and/or symptoms of depression 
• Emotional numbness 
• Low self-esteem, low self-worth 
• Helplessness 
• Poor eye contact 
• Hyper-vigilance 
• Appearing isolated from family or friends 
• Expressing homicidal feelings towards another person 
• Appearing anxious about something that would not normally create anxiety, such as getting home late, going somewhere alone
• Pattern of making and missing appointments that is poorly explained 
• Unexplained increase in absence from work or class 

Hate Crimes

A hate crime is a criminal act against a person or their property because of that person's actual or perceived race/ethnicity, religion, nationality, disability, gender, gender identity, gender expression or sexual orientation. 

A hate incident is an act that, while not meeting the legal definition of a crime, involves the same behaviors and targeting of underrepresented groups. Hate incidents are more common on college campuses than hate crimes. 

Examples:

• Using force or threatening to use force to injure, intimidate or interfere with another person who is exercising their constitutional rights 
• Defacing or damaging another person's property to intimidate or interfere with that person's free exercise of their constitutional rights 
• Desecrating a religious symbol or displaying a swastika on another person's property with the intent to terrorize another person 

Effects on the victim:

• Depression
• Anxiety
• Symptoms of PTSD
• Intrusive thoughts
• Recurring dreams; disturbed sleep
• Refusal or inability to discuss the event
• Pulling away emotionally from others
• Irritability, dDifficulty concentrating and disturbed sleep
• Impact an individual's ability to work/go to school or to maintain healthy relationship
• Substance abuse or violent behavior
• Physical health problems such as severe headaches, gastrointestinal problems and insomnia. 

Effects on Communities: 

• Feel unwelcome and unsafe in a particular neighborhood, community, school, workplace or other environment.
• Being a member of a victimized group who you vicariously observe may also lead to mental health problems.

Resources:

• Human Rights Campaign
• Anti-Defamation League 

Hazing:

Students attending the University of San Francisco have the opportunity to join a wide range of groups, including athletic teams, fraternities and sororities, performing arts ensembles, religious groups, public service organizations and others. These groups, by and large, provide positive out-of-the classroom learning experiences and are important platforms for social, cultural and interpersonal support. Entry into some of these groups may involve formal or informal initiation practices, which, in and of themselves, are not harmful to a student's academic experience. There are, however, times when these practices become hazing, and are detrimental to the student. Hazing is defined as any action taken or situation created on or off campus that recklessly or intentionally produces mental or physical discomfort, embarrassment, harassment or ridicule. 

Facts about hazing:

• Hazing in any form is prohibited at USF. 
• Hazing is illegal in the state of California. 
• Hazing can be psychologically damaging and present serious physical risks to students. 

Some of the signs of a student experiencing hazing:

• Fatigue

• Unkempt appearance

• Wearing conspicuously strange or silly clothing;

• Falling behind in work or performance

• Change of attitude or personality in class

Learn more at Stop Hazing 

Responding to Reports of Trauma or Abuse 

What you can do: 

• Listen carefully and validate the student's feelings and experiences. 
• Recognize that the student may be feeling vulnerable and experiencing a range of emotions. 
• Encourage the student who is being stalked/harassed to trust their instincts. 
• Advise the student to document unwanted contacts and maintain evidence of harassment/stalking/abuse. 
• Advise the student to take precautions to increase safety, including a change in routine travel routes and schedules. 
• Let the student know that there are services available on campus to assist and support them.
• After providing referral information, allow the student to make their own decision about what to do next. 
• If the student wants to file a complaint, direct them to the Public Safety or Title IX Office. 
• If the student is not receptive to the referral initially, they may be more open to help upon further reflection and follow-up - check back with the student.
• Be willing to offer flexible arrangements (e.g., extension on a paper or exam), if appropriate, as a way to alleviate stress.

What to avoid:

• Downplaying the situation. 
• Believing the incident was not traumatic if the student does not appear distressed. 
• Avoid conveying criticism, judgment or implying the student was somehow responsible, even if the student engaged in high-risk behavior (e.g., was intoxicated or high, left a party alone with someone he/she just met). 
• Avoid telling the student what to do or trying to coerce them into seeking assistance.
• Expecting the student to make quick decisions or changes. 
• Telling the student to forget about it and move on. 
• Questioning the student for details about the incident.
• Pressuring the student to file a police report. 
• Taking responsibility for the student's emotional condition. Know your limitations and utilize your support system. 

Referrals: 

• CAPS  415-422-6352
• ODOS  415-422-5330
• Title IX Office  415-422-5330
• An Abuse, Rape & Domestic Violence Aid & Resource Collection 
• U.S. Department of Justice Office on Violence Against Women 
• National Center for Victims of Crime/Stalking Resource Center 
• National Domestic Violence Hotline 
• California Coalition Against Sexual Assault 
• Men Can Stop Rape 
• Stop Hazing 
• Human rights Campaign 

General Health & Wellness Distress 

Students may become distressed due to trouble with transitions, academic difficulties, or health and wellness concerns. In this section, we will provide information on health and wellness concerns and list educational resources for anyone interested in learning more. At the end of this section, you will find general tips for responding if you become aware that a student is struggling with any of these concerns. 

Academic Difficulties

When students do not succeed at USF, the reason is seldom that they are intellectually incapable of doing the work; something outside school gets in their way: lack of motivation or discipline, mismatch with program, immaturity, alcohol, illness, emotional problems, learning disabilities, attention deficit disorder, family issues or financial difficulties. 

Many students who struggle academically are doing so for the first time in their lives. They are used to succeeding, and their reactions to not doing well in a course vary widely. 

Some students will withdraw. Some will complain loudly. Some will doggedly persevere. No matter the response, it is vital that you give students the grades they earn. Maintaining academic standards is critical for your sake, for the sake of the students and for the sake of the university. 

CASA is committed to empowering students to achieve their academic goals and provides academic related services to students to get guidance on completing forms, and get connected to resources. To accomplish this, CASA's success coaches:

• Empower students through coaching to achieve academic success.
• Connect students to academic programs and resources on campus
• Provide a supportive environment that promotes personal growth 
• Help students develop skills to successfully meet the demands of a rigorous curriculum

Learn more:

• ULifeline 
• Set to Go, A JED Program

Financial Difficulties

Seven out of 10 college students feel stressed about their personal finances, according to a new national survey. Ohio State University’s 2015 National Student Financial Wellness Study found that a staggering 70 percent of college students reported feeling stressed about their finances. Nearly 60 percent of respondents said they worry about having enough money to pay for school, while half are concerned about paying their monthly expenses. 32 percent of students reported neglecting their studies at least sometimes because of the money they owed. In addition, Wisconsin Hope Lab (now the Hope Center for College, Community and Justice) found that housing and food insecurity are far more prevalent among college students than previously thought (Scholarship America, 2019).

USF provides the below resources for students who experience financial difficulties: 

• The Office of Financial Aid provides assistance through the Financial Aid Guide, applying, completing and accepting financial aid and information on sources of financial aid.
• The University of San Francisco’s Food Pantry is available to all undergraduate and graduate students enrolled at the University. The pantry is meant to provide an intermediate solution for students who are experiencing food insecurity            (having limited or uncertain access to a sufficient quantity of food)
• The Student Employment Office helps document work eligibility, coordinate Federal Work-Study, and identify off-campus FWS positions. 

Adjustment Transitions

Transitions involve both loss and opportunity. Entering college is one of life's most demanding transitions — arguably the most significant transition since the start of kindergarten. Transitions can pose greater problems to students who have existing psychological problems or difficult life circumstances. 

Both undergraduate and graduate students face many challenging transitions, including degree completion and entering the workforce. The changes inherent in a transition can produce stress and challenge a student's coping resources. It is common for students to experience a decline in functioning (academic, social, emotional) during transitions. The stress can be compounded by counterproductive coping mechanisms

Learn more: 

• Set to Go, A JED Program
• PsychCentral Article 

Substance Abuse

Students who abuse alcohol or other drugs cause significant problems for themselves and those around them.  Recent research shows that approximately 4 out of 5 students drink alcohol and that there has been an increase in the number of college students engaging in binge drinking. Since legalization, marijuana use is escalating. Prescription stimulants (such as Adderall or Ritalin) are also frequently abused . Students who do abuse prescription stimulants are significantly more likely to also abuse alcohol and other drugs.

Research finds that 31 percent of undergraduates can be defined as meeting the criteria for substance abuse and 6 percent meet the criteria for dependency. While the level of abuse drops among graduate students, the rate of dependency does not. 

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the consequences of alcohol use for college students are wider and more destructive than commonly realized. Alcohol use by college students may lead to and/or contribute to decreased academic performance, relationship loss/changes, accidents, assault, drunk driving, alcohol dependence, vandalism, unsafe sex, sexual assault or date rape, alcohol poisoning and even death. 

Faculty and staff may become aware of student alcohol/substance problems 

when it affects the student's classroom behavior or academic performance, or if they encounter a student coming to class intoxicated or high. 

Signs and symptoms: 

• Decline in class attendance (e.g., tardiness, disappearance from class for long periods of time, sick more frequently) 
• Decline in academic performance (e.g., missed deadlines, not performing at usual level of competence) 
• Physical signs (e.g., bloodshot eyes, slurred speech, poor hygiene, sudden weight loss or gain) 
• Behavioral signs ( e.g., avoiding eye contact, fatigue, hyperactive) 
• Changes in mood (e.g., depression, emotional instability, angry, irritable, aggressive behavior) 

Learn more: 

• National Institute on Alcohol Abuse and Alcoholism  
• The Association of Recovery in Higher Education (ARHE) 
• Transforming Youth Recovery 
• Half of Us 

Self-Injury

Self-injury is sometimes called "self-harm," "self-mutilation," "cutting" or "non suicidal self-injury." Self-injury typically refers to a variety of behaviors in which an individual intentionally inflicts harm to their body for purposes not socially recognized or sanctioned.  Self-injury is most commonly associated with intentional carving or cutting of the skin, subdermal tissue scratching, burning, ripping or pulling skin or hair; self-bruising and breaking bones. 

Detecting and intervening in self-injurious behavior can be difficult since the practice is often secretive and involves body parts that are relatively easy to hide. The intensely private and shameful feelings associated with self-injury prevent many from seeking treatment. It is important that questions about marks be non-threatening and emotionally neutral. Evasive responses from those engaging in self-injury are common. However, concern for their well-being is often what many who self-injure most need; persistent but neutral probing may eventually elicit honest responses. 

Signs and symptoms:

• Constant use of wristbands/coverings
• Frequent bandages
• Scars from burns or cuts 
• Fresh cuts, scratches, bruises or other wounds 
• Broken bones 
• Keeping sharp objects on hand 
• Wearing long sleeves or long pants, even in hot weather 
• Claiming to have frequent accidents or mishaps 
• Spending a great deal of time alone 
• Pervasive difficulties in interpersonal relationships 
• Statements of helplessness, hopelessness or worthlessness 

Learn more: 

• The Cornell Research Program on Self-Injury and Recovery 
• Half of Us 
• ULifeline

Responding to General Health & Wellness Distress

If you become aware of a student who is in distress caused by general health and wellness concerns consider the following tips and referrals: 

What you can do: 

• Listen carefully and validate the student's feelings and experiences. 
• Express your genuine concern for the student, focusing on specific behavior and/or changes you've observed  
• Be prepared for the student to deny any problem and to reject your help. 
• Set appropriate and firm limits with students
• If the student comes to class intoxicated or high, is disruptive and refuses to leave, contact Public Safety for assistance. 
• Encourage the student to use positive coping strategies to manage transition stress, including regular exercise, use of social support, a reasonable eating and sleeping regimen, and scheduling pleasurable activities
• Refer a student to CAPS. They may be experiencing anxiety and/or depression.  
• Follow up with the student after making the referral. If the student was not receptive to the referral initially, they may be more open to help upon further reflection and/or follow-up.
• Be aware of your own feelings and reactions. It is natural to feel frightened, overwhelmed and helpless. 

What to avoid:

• Punishing the student for maladaptive behaviors. 
• Assuming that the student understands the impact of their behaviors and is aware of the source of stress. 
• Discounting or overlooking factors that put the student at risk for more serious problems. 
• Denying or ignoring your observations of the student's academic or behavioral changes. 
• Attributing common signs of alcohol/substance use or abuse to "experimentation." 
• Ignoring or tolerating the student's disruptive behavior. 
• Communicating your concern in a critical and/or judgmental manner. 
• Arguing with the student if he/she expresses denial of a problem. 
• Trying to force a disruptive or intoxicated student to leave the class. In these cases, call Public Safety
•  Making comments that are judgmental of their self-injury or tell the person to stop the self-harming behavior. 
• Remain calm.  

Distressing & Disruptive Students

On occasion, you may find a student whose behavior is causing distress for you or others. These types of concerns vary greatly but can be broadly categorized by those who are excessively demanding or dependent, and those who are aggressive or perceived to be potentially violent. 

Excessively Demanding/ Dependent Student

There are invariably some students whose personal styles create interpersonal difficulties for those around them. These students often appear to possess a sense of entitlement, appear unwilling to listen, appear unable to take "no" for an answer, exhibit disrespect or verbal abuse toward others, or act in a persistently demanding way. 

Others arrive on college campuses with interpersonal skills honed in a less stressful environment where less is expected of them and more support is available, or where they have not been allowed to act independently. Students may be used to operating in an academic community, where it is easier to access needed information, parental figures are available to help and much more of their life is structured for them. USF students may find that they are overwhelmed and lack necessary skills to negotiate college situations. 

Students who are demanding may be intrusive and persistent and may require more time and attention. Demanding traits can be associated with anxiety, panic, depression, personality problems and/or thought disorders, mania, drug use/abuse. 

It is important to be aware of your own tolerance level and what you can offer 

the student. If the same student has returned for help day after day, or, for whatever reason your own stress level is high, it might be advantageous to ask a colleague for help. With the help of a colleague it can sometimes be easier to set boundaries, to check lists of resources, to get another opinion on the level of the student's distress.  

Signs and symptoms:  

• Sense of entitlement 
• Inability to empathize 
• Need for control 
• Difficulty in dealing with ambiguity 
• Intrusive and persistent 
• Strong drive for perfectionism 
• Difficulty respecting structure, limits and rules, boundaries
• Dependency on others to take care of them 
• Fears about handling life  

Learn more: 

• National Behavioral Intervention Team Association (NaBITA) 

Aggressive/ Potentially Violent Student

It is difficult to predict aggression. When a student is faced with a frustrating situation that is perceived to be insurmountable, the student may become angry and direct that anger toward others. Despite high profile cases, a student acting out violently is a fairly rare event. 

The access to drugs or alcohol for some may increase the propensity for more aggressive behavior. In some cases, the aggression may be indicative of the onset of a mental health disorder. Understand your own sense of safety and ask for assistance if you feel threatened. 

Signs and symptoms:

• Hostile, suspicious and agitated behavior. 
• Hyper-vigilance (i.e., looking around a lot)
• Extreme dependency 
• Delusions and hallucinations
• Fearfulness
• Predatory behavior.
• Loud and pressured speech

If there is an imminent threat of harm Call Public Safety immediately!

Learn more: 

• National Behavioral Intervention Team Association (NaBITA) 

Responding to Distressing Students 

What you can do:

• Talk to the student in a place that is safe and comfortable.
• Remain calm and take the lead. ("Tell me what is bothering you and then let's decide what solutions there might be.") 
• Set clear limits up front and hold the student to the allotted time for the discussion.
• Emphasize behaviors that are and aren't acceptable. ("If you want me to continue with this, I will need you to be as respectful of me when you are talking.") 
• Respond quickly and with clear limits to behavior that disrupts class
• Be prepared for manipulative requests and behaviors. ("You came asking for my help and I have offered you several ideas, but they do not seem okay with you..")
• Maintain a posture that is poised, ready to move quickly, but not fearful. 
• Maintain a voice quality that is matter-of-fact, monotone. 
• Use clear, assertive statements of consequences; repeat as necessary. 
• Use eye contact sparingly — only to emphasize a point. 
• If you feel it is appropriate to continue meeting with a distressing student, remain in an open area with a visible means of escape (keep yourself at a safe distance, sit closest to the door and have a phone available to call for help). 
• Use a time-out strategy (ask the student to reschedule a meeting with you after they have more time to think). 
• Enlist the help of a co-worker (avoid meeting alone or in a private office with the student). 
• Assess your level of safety and be cognizant of your intuition. Call Public Safety if you feel the student may harm him/herself, someone else or you. 
• Familiarize yourself with the RED FOLDER, so that you are prepared when the need for this information arises. 

What to avoid:

• Arguing with the student. 
• Giving in to inappropriate requests. 
• Adjusting your schedule or policies to accommodate the student. 
• Ignoring inappropriate behavior that has a negative impact on you or other students. 
• Feeling obligated to take care of the student or feeling guilty for not doing more. 
• Allowing the student to intimidate or manipulate you to not deal with the problematic behavior. 
• Staying in a situation in which you feel unsafe. 
• Ignoring signs that the student's anger is escalating (body language, clenched fists). 
• Becoming hostile or punitive toward the student. 
• Making threats or dares. 
• Touching the student or crowding their sense of personal space. 
• Ignoring a gut reaction that you are in danger. 

Referrals and consultation: 

• Public Safety or 911 
• ODOS
• CAPS

WHAT CAN FACULTY AND STAFF DO TO REDUCE STRESS

Am I CAUSING Undue Stress? 

Despite good intentions, in your pursuit to push our students towards academic excellence, have you ever considered you may be causing undue stress? While one approach is to build resilience in our students we also ask that our faculty and staff reflect on their interactions with students. 

Consider the following: 

• Do you often encourage competition between your students? 
• When you have to turn down a student's request, do you offer alternatives or leave them to figure out next steps on their own? 
• Are you quick to hand out criticism, or are you thoughtful about giving negative feedback? 
• Has a student ever left your office crying after communicating about their work? 
• Has a student ever told you they were afraid to come to your office hours? 
• Do you find yourself feeling impatient or annoyed when communicating with students? 
• Have you ever been dismissive of a student when you felt their complaint/concern was unfounded? 
• If you examined your interactions, would you notice a difference in how you treat your higher vs. lower achieving students? 

Get to Know Your Students 

Social support and a sense of a larger community promote well-being and are the best insurance against stress and self-harm. USF students overwhelmingly state that they want to be part of a supportive community. They want to get to know and work with their professors and bond with the staff. Learn your student's names. You may not be able to learn them all, but don't let this stop you from learning as many as you can.

Fostering Cooperation vs. Competition 

• Cooperative Groups — Pose a question to be worked on in each cooperative group and then circulate around the room answering questions, asking further questions. After an appropriate time for group discussion, students are asked to share their discussion points with the rest of the class. 
• Active Review Sessions — Veer away from the traditional question and answer review format. Instead, encourage:
• Open discussion for students to recognize critical concepts
• Broader participation to brainstorm different approaches to problem-solving skills 

Being Clear in Expectations and Communication 

Clear and consistent communication enables students to get the most out of their undergraduate education. Without accurate information, students feel that everyone else is doing well and that they are the only ones struggling. Provide regular feedback. 

Suggestions:

• Overall course objectives; consider the personal tone that you set as an important aspect of the syllabus 
• Course format, so students know how you will be using class time 
• Your expectations of student responsibilities 
• What assessment techniques you will use to evaluate students, including information on grading policies 
• A schedule of class dates and topics, along with week-by-week reading assignments 
• Due dates for papers, exams, and projects, including policies about late assignments 
• Any pertinent information about academic policies and procedures (such as class attendance, making up assignments and universitywide policies) 

Consider adding the following statement to your course syllabus: 

Mental Health & Wellness 

As a student you may experience a range of issues that can cause barriers to learning. These stressful events may lead to diminished academic performance or reduce a your ability to participate in daily activities. If you are suffering from any of the aforementioned conditions, consider utilizing the confidential mental health services available on campus. Reach out to CAPS for support (https://myusf.usfca.edu/caps or 415-422-6352). An on campus counselor or after-hours clinician is available 24/7. 

Evaluate Students without Causing Undue Stress  

Test in the same manner in which you teach. Be sure that a test measures what students have learned. Provide specific feedback and corrective opportunities. Grade inflation is a problem — 95 percent of students think that they are failing if they don't get all As. Negotiating flexibility can be difficult while also striving for academic excellence. 

Suggestions: 

• Test exams on a colleague before handing them out to your class. 
• Consider untimed exams. While this is vital for students with some learning disabilities, it can also reduce tension for mainstream students. 
• Consider providing practice exams or old exams or review sessions for an exam. 
• Establish a formalized mechanism through which students can appeal project/ paper deadlines or ask for an exam make-up. 
• Consider allowing students illness/personal absence days without requiring documentation from a medical provider. This not only causes students to "medicalize" their needs, but uses up valuable staff resources for truly ill students. 

Focus on Strengths

Research on achievement motivation suggests that students whose motivation is to avoid failure is greater than their motivation to succeed are more likely to expect negative outcomes when faced with challenges, have increased cognitive anxiety, ruminate on failure, exhibit avoidance behaviors and generally underperform. Students whose motivation to succeed is higher than their motivation to avoid failure are often more future-oriented, more willing to be involved in innovative activities, more apt to see challenges as motivating and often push limits to solve complex problems. 

RESPONDING TO A STUDENT MENTAL HEALTH AND WELLNESS SITUATION: 

A Quick Decision Tree for Faculty-Staff Action

1. Determine if the situation is an emergency. (EMERGENCY: Call Public Safety 415-422-2911 or 9-1-1)
2. Determine if situation is Serious but non-emergency: Notify the Office of the Dean of Students 415-422-5330 or Red Folder report with your concerns including:

• Student’s full name
• Student’s ID number
• Students academic program
• Student’s living arrangement (on or off campus)
• A brief summary of the situation

     3. If appropriate for CAPS, contact CAPS in advance and

• Call CAPS with the student, if possible
• Arrange for the student to be seen in CAPS on that day
• Arrange for the student to be seen in CAPS sometime in the next 48 hours

References 

Holm‐Denoma, J. M., Scaringi, V., Gordon, K. H., Van Orden, K. A., & Joiner Jr, T. E. (2009). Eating        disorder symptoms among undergraduate varsity athletes, club athletes, independent exercisers, and nonexercisers. International Journal of Eating Disorders, 42(1), 47-53.

Kaye, W. (2008). Neurobiology of anorexia and bulimia nervosa. Physiology & behavior, 94(1), 121-135.

Keel, P. K., Dorer, D. J., Eddy, K. T., Franko, D., Charatan, D. L., & Herzog, D. B. (2003). Predictors of mortality in eating disorders. Archives of general psychiatry, 60(2), 179-183.

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If a USF student is experiencing a current psychological crisis, they will be seen by a CAPS therapist during business hours the same day (typically within an hour or two, depending on therapist availability). Please call ahead to alert us in the event that you are referring a student in crisis to CAPS.

A student who is in crisis outside of business hours can call CAPS' All Hours Line at (855) 531-0761 to talk to a professional therapist by phone, who will assess their safety, provide support, and connect the student wit resources if needed. Staff and faculty concerned about a USF student's mental health can also call CAPS during business hours (415-422-6352) or the All Hours Line 24/7 to consult.

Confidential and free short-term mental health services are offered through CAPS by licensed psychologists, doctoral-level interns, and postdoctoral fellows. We provide crisis intervention and a variety of time-limited mental health services to currently enrolled students. We also consult with staff, faculty, family, and friends about USF students of concern. When CAPS is not able to provide a service that a student may need, we provide referrals to other on-campus and/or off-campus resources.

Communication between CAPS therapists and clients is confidential. We cannot discuss whether therapy is being received or the details of a student's situation without their written consent. If you wish to have notification of a student's attendance of therapy, please discuss this with the student prior to their coming to CAPS; if the student is willing, they can sign a release form allowing CAPS to contact you and/or other relevant parties.