For students, college is a time of transition, including developmental challenges such as individuating from parents, forming intimate relationships and establishing a social and personal identity. Students often seek help from others for these concerns, as well as for situational difficulties (e.g., failing a course, losing a loved one, romantic situations, or roommate conflicts). Research shows, however, that severe mental health problems are being manifested among students more frequently than in the past.

Faculty and staff, especially when in advising and coaching roles, are often the people to whom students first show their difficulties and a need for help through classroom behaviors, academic performance and/or personal disclosures. It is important for faculty and staff to be able to recognize the signs of distress that students show, to know the parameters of their roles as advisors, coaches and mentors, and to effectively refer students to appropriate mental health resources when needed.

Parents and friends who know the student well can also detect changes in a student’s behavior that indicate difficulties. Some guidelines and information are provided below to assist in this process of problem recognition and referral for help. 

Characteristics of Troubled Students
Problem behaviors may be manifested in the classroom, in advising sessions, in living areas, or during informal interactions, among other ways. Faculty and staff who have regular contact with students in these ways are in good positions to assist with early detection and referral. Parents may learn about some of these behaviors through email or phone calls. Roommates and friends are the day-to-day observers of signs of distress and malfunctioning. It is very important for others to recognize the signs of distress in students. Some examples listed below show a range of problem behaviors that may be indicative of adjustment or mental health concerns.

• Extremely poor academic performance or a change from high to low grades

• Excessive absences, especially if prior class attendance was good

• Unusual or noticeably changed interaction patterns in the classroom

• Depressed or apathetic mood, excessive activity or talkativeness and evidence of crying

• Noticeable change in appearance and hygiene

• Alcohol on the breath/problem drinking patterns or similar issues with other substances

• Inability to remain awake in class

• Repeated attempts to obtain deadline extensions or postpone tests

• Dependency

• New or continuous behavior which disrupts class or student interactions

• Inappropriate or exaggerated emotional reactions to situations, including a lack of emotional response to stressful events

• Seeking help from multiple other parties instead of counseling professionals

• Violent or other extremely disruptive behavior

• Obvious loss of contact with reality

• Disturbed speech or communication content

• Suicidal or other self-destructive thoughts or actions; references to death

• Homicidal threats (contact law enforcement immediately)

Symptoms of Specific Psychological Problems

Depression

• Low self-esteem

• Difficulties making decisions 

• Feelings of sadness, helplessness, hopelessness

• Sleeping too much or too little

• Weight gain or loss

• Overeating or loss of appetite

• Loss of interest in sex

• Tearfulness or crying

• Withdrawal from others

• Loss of interest in activities previously enjoyed

• Decreased motivation

• Alcohol or other drug abuse

• Pessimism

• Problems with concentration or memory

• Thoughts of death or suicide 

Anxiety

• Constantly moving around or being fidgety

• Inability to relax

• Nervousness

• Physical sensations like heart pounding, feeling dizzy, breathing difficulty and/or trembling

• Feeling pressured

• Excessive worry

• Inability to make decisions

• Problems sleeping

• Difficulty concentrating 

Alcohol Abuse or Dependence 

• Using alcohol to cope with difficulties

• Drinking more often or in larger amounts

• Hiding drinking from others

• Gulping drinks or binge drinking

• Getting annoyed with others who comment on how much is consumed

• Being uncomfortable when alcohol is not available

• Feeling guilty about drinking

• Unsuccessfully being able to decrease drinking

• Drinking more than planned

• Drinking in the morning

• Memory loss, blackouts

• Drinking to feel normal 

Anorexia 

• Significant weight loss or being severely underweight

• Restricted/reduced food intake

• Ritualistic eating patterns

• Denying hunger

• Being perfectionistic

• Excessive exercise

• Distorted body image

• Very self-controlled

• Withholding feelings 

Bulimia 

• Frequently going to the restroom after meals

• Mood swings

• Buying large quantities of food that disappear suddenly

• Swelling around the jaw

• Weight may be normal

• Frequently eating large amounts without gaining weight

• Buying large amounts of food and eating it on the spur of the moment

• Laxative or diuretic use

Other Symptoms 

• Delusions

• Hallucinations (e.g., hearing voices or seeing things that others do not hear/see)

• Disorganized speech (e.g., incoherent, tangential)

• Disorganized or catatonic behavior 

When to Refer 

Whenever any of the signs of difficulties listed above are present and a student is not functioning at an optimal level, a referral to the Counseling Center could be recommended. Often an empathic listener or a trusted mentor can provide the support, guidance or perspective to sufficiently help a student through a difficult situation or time in life. Teachers, advisors, Student Affairs staff, and university personnel, in general, are dedicated to helping students learn, grow and succeed. There are times, however, when the help of professionals trained to deal with psychological issues and problems is recommended. Faculty and staff should consider referring a student to the Counseling Center in the following situations:

• A student asks for help with a problem outside of your realm of expertise

• The student feels uncomfortable talking to you about the problem

• What you have done so far has not sufficiently helped reduce or solve the problem

• The student’s behavior is disrupting others

• Helping the student could represent a conflict of interest or dual relationship and compromise your objectivity

• You are having a strong emotional reaction to the student’s situation (e.g., feeling overwhelmed, overly responsible, afraid, or tired)

• You are extremely busy or stressed, or unwilling or unable to offer the necessary help

How to Refer 

Some aspects of making an effective referral include helping the student see that there may be a problem, showing care and instilling a sense of hope and confidence in the remedy through counseling. Specific suggestions for referring are provided below:

• Talk to the student in private

• Express concern, while being specific about particular troubling behaviors

• Listen empathically

• Remain neutral

• Suggest to the student that it would be helpful to talk to someone at the Counseling Center who is trained to address his/her concerns in a confidential manner

• Have the student call to schedule an appointment from your office, if he/she is willing

• Demystify and destigmatize counseling as necessary

• Call a counselor yourself to consult about the student’s circumstances

• Obtain emergency help via University Police if there is a threat of danger or harm

• Follow up with the student to find out if he/she kept the appointment; do not inquire about details of the session; rather, just show an interest in knowing that the student is getting the help he or she needs

If you are a student in crisis, an on-call counselor is available in University Women 110 or 111 or by phone (405) 466-3400, 8:00 a.m. to 5:00 p.m., weekdays. After hours counselors are available by phone through a resource named Call SAM at (855) 225-2726 or by contacting the Langston University Police at (405) 466-3366 or 911.