Mental Health Concerns: How and When Should I Help?

Lifeguards are trained to recognize signs that a swimmer is going under the water and struggling to stay afloat. When it comes to student mental health, a struggling student may also display common signs and symptoms of distress. By being mindful of these signs, a concerned party can provide a needed life-preserver in the form of a referral to a caring mental health professional. While not an exhaustive list, the signs and symptoms listed below (courtesy of the Mayo Clinic) are among the ones we might expect to see among college-aged students in distress:

Depression

• Feelings of sadness, tearfulness, emptiness or hopelessness

• Feelings of worthlessness or excessive guilt

• Angry outbursts, irritability or frustration, even over small matters

• Loss of interest or pleasure in most or all normal activities

• Tiredness and lack of energy, so even small tasks take extra effort

• Slowed thinking, speaking or body movements

• Sleep disturbances (sleeping too much, or too little)

• Eating disturbances (eating too much, or too little)

• Trouble thinking or concentrating; difficulties with memory

• Frequent or recurrent thoughts of death or suicide

• Unexplained physical problems, such as back pain or headaches

 
Anxiety

• Feeling nervous, restless or tense

• Having a sense of impending danger, panic or doom

• Physical symptoms including increased heart rate, rapid breathing, sweating, and/or trembling

• Feeling weak or tired

• Trouble concentrating or thinking; mind going ‘blank’ 

• Having difficulty controlling worry

• Difficulty sleeping

• Experiencing gastrointestinal (GI) problems

• Having the urge to avoid things that trigger anxiety

Substance (Drugs, Alcohol) Misuse

• Feeling the need to use the substance regularly

• Having intense urges for the substance that block out other thoughts

• Over time, needing more of the substance to get the same effect

• Taking larger amounts of the substance, over a longer period of time than intended

• Making certain to maintain a supply of the substance

• Spending money on the substance, even though can't afford it

• Not meeting obligations; cutting back on social or recreational activities

• Continuing to use the substance, even though it's causing life problems 

• Doing illegal or immoral things to get the substance (e.g. stealing)

• Engaging in risky activities when under the influence of the substance

• Spending a good deal of time getting the substance, using the substance or recovering from the effects of the substance

• Failing in attempts to stop using the substance

• Experiencing withdrawal symptoms when one attempts to stop taking the substance

Eating Disorders

• Skipping meals or making excuses for not eating

• Adopting an overly restrictive diet

• Dieting all the time

• Excessive focus on healthy eating

• Withdrawal from normal social activities

• Persistent worry or complaining about being fat and talk of losing weight

• Frequent checking in the mirror for perceived flaws

• Repeatedly eating large amounts of sweets or high-fat foods

• Use of dietary supplements, laxatives, or herbal products for weight loss

• Excessive exercise, even and especially when injured

• Calluses on the knuckles from inducing vomiting

• Problems with loss of tooth enamel that may be a sign of repeated vomiting

• Leaving during meals to use the toilet

• Eating much more food in a meal or snack than is considered normal

• Expressing depression, disgust, shame, or guilt about eating habits

• Eating in secret

Mania (a core feature of Bipolar Disorder)

• Abnormally upbeat, jumpy, or wired

• Increased activity, energy, or agitation

• Exaggerated sense of well-being and self-confidence (euphoria)

• Decreased need for sleep

• Unusual talkativeness

• Racing thoughts (not better described as anxious worry)

• Distractibility

• Poor decision-making — for example, going on buying sprees, taking sexual risks, or making foolish investments

Schizophrenia

• Delusional beliefs not based in reality

• Hallucinations; sensory perceptions of things that do not exist 

• Disorganized thinking; (as expressed by highly disorganized speech). 

• Extremely disorganized or abnormal motor behavior. 

• Neglect of personal hygiene

• Loss of emotionality

• Loss of joy, or interest in daily activities

• Withdrawal from others

If you notice one or more signs from the list of signs and symptoms above, it may or may not be cause for concern. Here are some general rules of thumb when it comes to warning signs:

Duration matters. Imagine a friend who has a "bad day" and doesn't want to leave their bed. The next day they shake it off and it looks like they are back on track. Contrast this with another friend who is having trouble getting out of bed more days than not for a period of two weeks. Duration matters because bad days are expected, and as long as someone is bouncing back from them there is probably little need to worry. But when someone can't seem to "snap out of it" this likely indicates cause for concern.

Functioning matters. For most college students, doing well at school is their primary "occupation." Getting up on time for classes, practicing good-enough hygiene, attending and engaging with lectures, completing assignments, and studying for exams are the tasks they are expected to perform. When emotional or behavioral distress gets in the way of doing their "job" this is an indication that they may need some additional support to bounce back to good functioning.

Symptom clusters matter. When symptoms cluster together, this is often suggestive of a problem. A drop in classroom attendance becomes more concerning, for example, when it occurs alongside an inability to concentrate, withdrawal from others, and increased substance use. A caveat to the idea of symptom clusters is that some signs or symptoms are so concerning that even if they are the only noticeable sign, it would be important to intervene (for example, when a student is expressing thoughts of suicide or experiencing hallucinations). 

Unhealthy changes in behavior and attitude matter. College is a time for self-exploration. It is normal for a college-aged person to try new ways of being, and new ways of interacting with others. In the absence or risk and erratic behavior, and in the presence of their usual good values and morals, this is a positive sign of development. Risky or health-threatening behaviors, however, are a cause for concern. Examples of these would include substance misuse, self-harm, self-malnutrition, or any other kind of violent behavior. Erratic behavior or sudden shifts in personality or mood should also focus your attention on the possibility something is amiss. Similarly, changes in belief system towards a radical or hateful ideology could signal that a student is struggling. 

Context matters. There are some life events that can hit particularly hard in the life cycle of a college student. These almost always involve some form of loss or transition. Recognizing that loss and transition are challenging can help you be tuned in to whether a friend, student, or child is coping effectively (or ineffectively) during these times.

Examples of challenging life events for a college student might include: 

• Death of a family member, partner or best friend

• Loss of any major relationship

• The divorce or separation of parents

• The adolescent’s own pregnancy or illness

• A loss or change in residence; or a recent unwanted move

• Loss of family social or financial status

• Rejection by peers

• A significant failure to achieve

History matters. When thinking about whether to be concerned about a symptom of distress, a change in behavior, or some other potential sign that something is amiss it helps to keep an individual’s history in mind. Have they shared with you that they have a known history of emotional difficulty that precedes their time in college? Did they ever meet with a mental health professional in the past or receive a mental health diagnosis? Are you aware that they have become symptomatic in the past during times of loss or transition? If the answer to these questions is yes, then it may add some weight to the idea that their current distress is reason enough to check in with them to see if they are getting the support they need to thrive.

Always take talk about suicide seriously. In the United States a death by suicide occurs roughly every 11 minutes. Additionally, suicide is the second leading cause of death for individuals age 15-24. When a child, friend, or student mentions having thoughts of suicide or wanting to die this can trigger strong feelings of alarm in the person who hears it. As best you can, calm you alarms enough to convey that you are glad they are talking with you about this topic (rather than keeping it to themselves). Express hope that things can get better. Remind them that you are here to support them and that for you their health is paramount. Offer to get them whatever help they need and that getting mental health support is a courageous, positive step.

Concerned parties often feel hesitant to ask a student "are you in distress?" It’s common to worry that by asking a student if they are sad, or having a difficult time, or in some sort of emotional pain that the response will be negative, defensive or will somehow make matters worse. In reality, it is far more likely that by asking someone if they are suffering, you will convey to them that you care - and this can make all the difference. If you find yourself hesitating to ask a student if they are alright or if they need some help - don't wait, speak up. If you find that you can't ask, then delegate the task to someone who can.

Some tips for asking a student if they are in distress:

• Leave plenty of time for discussion.

• Try to speak in private if possible.

• Make use of observations and open-ended questions (for example: "I've noticed you've seemed tearful during class. It makes me think you might be going through a hard time. So, how are you doing?")

• Have resources (e.g., information about CAPS at Stevens) readily available to give to the student in case they agree to get help.

Individuals who are struggling with their emotional health may be reluctant to get help from a mental health professional. While speaking with them it can help to adopt an empathic, non-judgmental stance. Try to avoid getting into a tug-of-war. Ultimately, you want the student to feel heard, understood and cared for, while simultaneously planting the seed that professional help can improve their situation. Offer hope and suggestions for the ways in which treatment can help. 

Some examples of things you might say:

• “You know, mental health treatment really works. There's a lot of good research on talk therapy.”

• “Emotional distress is painful... and it also eventually passes. I think with some treatment what you’re going through could feel better sooner.”

• “Sometimes talking with someone can really help with shouldering the burden. It’s hard to do this alone!”

• “I know Dr. _____ at CAPS. She seems really great, and I know that she has helped other students who are going through moments that are similar to what you are going through.”

The QPR Institute, leaders in the field of suicide prevention, suggest that while any referral for help is a good one, some may be more effective than others.

• The best referral involves actually accompanying the person to a counselor or mental health professional.  

• The next best referral involves getting a commitment from someone to accept help, and then helping them set up a connection with a helping professional.

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• Third best is to give the student the contact information and encourage them to reach out to get help themselves.

On-Campus Counseling 

Counseling and Psychological Services (CAPS)

Student Wellness Center, 2nd Floor

201-216-5177 | CAPS@stevens.edu

Phone line is staffed 24/7 

National Emergency Counseling Resources

• National Suicide Prevention Lifeline

  • 1800-273-TALK

• Crisis Text Hotline 

  • Text "Hello" to 741-741

  • Students of color can also text "Steve" to 741-741

• Trevor Project Hotline

  • Resource for the LGBTQ+ community

  • 866-488-7386 | or Text "Start" to 678-678

• Asian Lifenet Hotline

  • 877-990-8585

  • Cantonese, Mandarin, Japanese, Korean, Fujianese spoken

In addition to the on-campus counseling service (CAPS), Stevens has two on-campus resources that can be of assistance in the event you are concerned about the well-being of a student:

The CARE Team

The CARE Team is a group of staff that receives reports made by individuals concerned about the well-being of a student. These reports are typically made by a faculty member, staff member, family member, or another student. When the CARE Team receives a report, it is assigned to a CARE Team member who then makes an attempt to speak with the student of concern and ultimately to connect them with a resource to help them (e.g., CAPS). 

• A CARE report can be submitted by emailing CARE@stevens.edu or by visiting this link.

• The CARE Team is not a 24/7 resource. A submitted report may not be read immediately.

• For situations that require an immediate response (e.g., a potentially life-threatening situation) contact the police.

Campus Police

Stevens Campus Police are available 24-hours a day, 365 days of the year. 

• In the event of a potentially life-threatening situation, they can be reached at 201-216-3911.

• For non-emergencies, you can reach them at 201-216-5105.

Local Police

In the event of a potentially life-threatening situation occurring off-campus, contact 911 or a local police department. 

Want more in-depth information on a particular topic or condition?

• Explore symptoms of mental health conditions courtesy of the National Alliance on Mental Illness.  

• Learn about signs of suicidality courtesy of the American Foundation for Suicide Prevention.

• Visit the Jed Foundation resource center for information about common emotional health issues and advice for teens and young adults on how they can support one another, overcome challenges, and make a successful transition to adulthood.

• Explore the Active Minds, Inc. website to learn more about the mental health challenges facing today’s youth and for tips on self-care and positive coping.