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1. Signs and indicators of psychological distress (“When is it appropriate to refer a student?”)

It is of paramount importance for staff members to be able to identify symptoms of psychological distress so that a referral can be made in time. The following table provides some examples of symptoms in different areas that could possibly be related to underlying psychological distress.

Changes observed in the following area: Examples 
Overall presentation  
  • Lack of motivation or withdrawn
  • Inability to concentrate
  • Excessive fatigue and exhaustion
  • Poor personal hygiene
  • Smell of alcohol or other substances
  • Substantial weight loss/gain
  
Emotional functioning  
  • Irritability or anger
  • Depressed, feelings of sadness or tearfulness
  • Anxiety or feelings of nervousness
  • Mood fluctuation
  • Unusual emotional outbursts or reactions
  
Behavioral functioning  
  • Suicidal threats, behaviors or attempts
  • Non-suicidal self-harming behaviors (e.g. self-mutilation/cutting, punching, kicking etc.)
  • Impulsive behaviors (e.g. excessive spending, unusual sexual behaviors etc.)
  • Unusual eating patterns (e.g. over-eating or under-eating)
  • Rapid or minimal speech
  • Disruptive behaviors or violence
  • Stalking or harassing others
  • Sleep disturbances (e.g. excessive sleep or insomnia)
  • Use of substances (e.g. cigarette, alcohol, marijuana or any non-prescribed medications or pills)
  
Academic functioning  
  • A sudden decline in academic performance
  • Substantial changes in quality of work or inclusion of inappropriate content in assignments submitted
  • Unable to meet academic deadlines, or, multiple requests for deadline extension
  • A sudden drop in class attendance, or, unable to stay throughout the whole class
  
Occupational functioning
  • Loss of a job
  • Poor work performance
  • Decrease in work productivity
  • Absenteeism or unable to be punctual
 
Social/Interpersonal functioning
  • Social isolation or excessive social activities
  • Changes in marital status or relationship (e.g. ending of an intimate partner relationship, sexually involved with multiple partners etc.)
  • Frequent arguments or conflicts with others
  • Act as a persecutor or become a victim of bullying

The above listed are just some examples (and not an exhaustive list) of symptoms that could possibly be related to underlying psychological distress and might warrant a referral to counselling service. Knowing an individual’s baseline of functioning is also important to determine whether or not the “change” is considered significant as each individual may have a varied degree of functioning. In case the changes are substantial, the student should be referred to a counsellor for a comprehensive assessment as soon as possible.

2. Tips for managing an urgent situation (“What to do when there is a crisis?”)

Due to the uniqueness of each individual student’s background and personality, flexibility is the key when dealing with students in need. . The level of urgency of the situation is the first and foremost factor to consider when deciding on the appropriate action to be taken.

A “crisis” is defined as when there is potential or reasonable suspicion that the student might be at “imminent” risk of harming himself / herself or others. It is important to bear in mind that there are times while the student might be at risk, he/she might not need an “immediate” intervention. By keeping the following questions in mind, you will have some brief ideas on whether or not the situation should be considered as a “crisis” and needs urgent attention.

  • Is the student at “imminent” risk?
  • Is the student at risk for harming himself/herself or others?
  • Do you feel unsafe about the current situation?

It is helpful to first differentiate whether or not the distressed student needs “immediate” intervention to deal with the corresponding situation. Answers to the above questions will help you determine the appropriate action that should be taken. The chart below provides details of actions to be taken when dealing with different situations.

urgent situation2

3. Tips for managing a non-urgent situation (“How to make an appropriate referral?”)

If the student does not appear to be at imminent risk, and hence does not require immediate action, but is obviously experiencing psychological distress, a referral can be made to CWS for counselling and emotional support.

Students may not be aware of the services provided by CWS and the potential benefits of on-going counselling with a counsellor. Also, they might not know that their presenting issues are something typical that clients bring in to counselling. Below are some examples of common presenting issues brought up by students during their counselling sessions:

  • Issues related to study: anxiety about academic performance, unable to concentrate during study, poor time management, and ineffective study skills etc.
  • Issues related to future planning: career goal setting, transitional issues around graduation, financial difficulties, anxiety with job search, unemployment, work-life balance etc.
  • Issues related to emotional and psychological stress: depressed mood, anxiety, hyperactivity, inability to relax, low motivation, sleep disturbances, disordered eating etc.
  • Issues related to painful memories: traumatic experience, domestic violence, childhood abuse or neglect, loss and grievances etc.
  • Issues related to relationships: campus or cyber bullying, poor social skills, conflicts with peer or significant other, family issues etc.
  • Issues related to self-exploration: self-identity development, self-image, self-acceptance, self-esteem and confidence issues, sexual orientation, religion, gender, cultural identity, values, developmental milestones and maturation etc.

It is quite common for students to seek help until when they are prompted by others, including parents, peers, professors or academic staff members. Early detection of symptoms and early interventions will help reducing the duration of suffering and preventing issues from escalating. It is thus very important for staff members to help identify students in need and encourage them to go for counselling service.

Please refer to the chart below for the recommended process for referring a student in need to see a counsellor.

nonurgent situation

4. Key points to remember:

  • “They” are NOT crazy!
    • Try to educate yourself and your students that the experience of mental health issues is perfectly normal and indeed common. Reaching out for professional help is actually a smart choice.
  • You do not need to “rescue”, but to “connect”!
    • You do not need to take up the emotional burden and deal with the issues for the student. Instead, you should engage the student and assist them to connect with CWS for professional help.
  • The earlier the better!
    • Try to refer right away when you start to feel concerned or have worry about a student. Do not wait until you consider the situation is a crisis to refer the student.
  • Do it right now!
    • Try to engage the student and connect him/her with CWS (if he/she agree to do so) while he/she is with you instead of relying on the student to set up an appointment himself/herself (especially if you notice that he/she is not motivated enough to do so).
  • You are not alone!
    • You do not have to deal with the situation that the student reports to you on your own. You can always reach out to CWS counsellor for consultation and support.
  • Always consult!
    • When you are not sure about how to properly manage an emotionally distressed student, please consider calling and consulting a CWS counsellor before taking any actions.