TRANSCRIPT: Mental Health & Suicide: Helping Yourself & Others

Speaker: Dr. Peggy Mitchell Clarke

Mental Health And Suicide: Helping Yourself & Others

Hi, I’m Dr. Peggy Mitchell Clarke. I’m a clinical psychologist and retired psychology professor. I taught at colleges and universities for almost 20 years. Thank you for viewing this very important video on student mental health issues. Let’s get started!

Workshop Goals 

The goal of this video is not to train you to diagnose yourself or your friends, but rather to help you to recognize the signs of several common mental health issues. Specifically, the objectives of this video are to:

Understand the symptoms of Major Depressive Disorder, Bipolar Disorder, Panic Disorder, and Posttraumatic Stress Disorder. Learn warning signs for suicide and review the steps involved in suicide assessment and crisis intervention and explore strategies for effectively responding to mental health concerns in yourself or someone you know.

Mental Health Issues

Many students-perhaps even you-struggle with depression and anxiety or have other mental health issues that interfere with the ability to succeed academically, personally, and socially. The signs of serious mental illness often first manifest in late adolescence and early adulthood-about the age that most students start college. Recent studies confirm that the number of college students with mental health issues is growing and there is an increase in the severity of the issues that they face. Do you know the signs of a mood or anxiety disorder? Would you know how to intervene if a friend were suicidal?

National College Health Assessment

The American College Health Association National College Health Assessment surveyed college students from around the country and found that within the last 12 months, 54% of students reported experiencing overwhelming anxiety, almost 87% reported feeling overwhelmed by all they had to do. Additionally, almost 60% of students surveyed reported feeling very lonely and about 82% felt exhausted, but not from physical activity. These statistics remind me of the first few weeks of my freshman year! Perhaps you or someone you know are feeling the same way. While these issues don’t necessarily mean something is seriously wrong, they may indicate that someone is struggling with a mental health issue.

Take Online Assessment

Let's pause for a moment. Here's an activity. 

This online assessment can identify if you are struggling with a mental health issue such as depression, anxiety, alcohol use, or trauma. At the end, if your results indicate you have an issue, you’ll be given some resources to get help.

Important Mental Health Issues

Clearly, mental disorders and mental health issues have a significant, negative impact on academic performance and our overall wellbeing. In this video, we will review the signs and impacts of the following disorders and issues: Major Depressive Disorder, Suicide, Bipolar Disorder, Panic Disorder, and Posttraumatic Stress Disorder or PTSD. We’ll start with Major Depressive Disorder first.

Major Depressive Disorder

Depression is diagnosed when someone has some of the following symptoms: Feeling Depressed or a sad mood. Loss of pleasure or interest in activities they previously enjoyed. For example, I had a student who previously enjoyed participating in the psychology club, was a very active member, and then during a depressive episode, lost interest in participating.

Feelings of worthlessness or excessive guilt - you’ll see this manifest in self blame, self denigration, and putting oneself down when you make mistakes. A person may show several physical signs such as insomnia or difficulty sleeping, fatigue, and significant weight loss or weight gain. Finally, the person may experience recurrent thoughts of death and/or actual suicide attempts. A student who is depressed may appear withdrawn from classmates and group activities, they may experience frequent absences or tardies, and they may demonstrate a lack of participation in classroom discussion. Combined with a lack of concentration, motivation, and ability to sustain effort, you may also see a dramatic drop in grades. Moreover, depression can lead to impaired judgment and thoughts of killing oneself.

How Can You Help?

To help a friend who shows signs of depression, try the following:

Talk to them and express your concern. Listen, offer your support, and take them seriously. Encourage them to get the help they need. Don’t stay silent; consult others (e.g., professor, advisor, counselor, RA)

Bipolar Disorder

Let’s take a look next at bipolar disorder. People diagnosed with Bipolar have a risk of suicide that is 15 times the general population. I once received a note from a student that mentioned “wild mood swings” and she later told me she had attempted suicide and was hospitalized over spring break. Bipolar is a disturbance in mood typically characterized by periods of mania and depression. We just reviewed what depression looks like, so now let’s see what it means to be manic.

Mania

Mania is when a person has a persistently elevated, expansive, or irritable mood that may involve grandiosity or inflated sense of self esteem. Manic students may be overly enthusiastic and promise more than they can deliver, or have grandiose ideas about projects that are unrealistic to complete. They will be more talkative than usual and may have pressured speech, for example speaking rapidly as if they must get out every word right away or they will explode. This may be disruptive to group activities or they may monopolize classroom discussions or the professor’s office hours. They may experience flight of ideas or racing thoughts, and when it becomes severe, mania can cause someone to become psychotic and they may have some overlapping characteristics to someone who has schizophrenia.

This may also make it hard for them to focus and concentrate on school work. A manic person will also often be easily distracted, hyperactive, or fidgety which may affect their ability to focus and follow directions. They may also be extremely pleasure-seeking and engage in self- destructive behaviors. I once had a student who had been diagnosed with bipolar and told me about a manic episode. She had engaged in a threesome with her male study partners and charged large sums of money on her credit card for things she didn’t need and couldn’t afford. A manic person may also go days without sleeping or sleeping very little.

Strategies

To help a friend who is experiencing a bipolar manic episode, help them stay organized and set realistic goals especially given their grandiose ideas. Frequent reminders or review might also help them stay focused if they are experiencing racing thoughts or flight of ideas. Also listen to what they are saying, ask how you can help, and if they are already getting professional help, encourage them to stick with their treatment plan.

Panic Disorder

Depression and anxiety are often what we call comorbid, meaning they co-occur, so let's take a look at an anxiety disorder called panic disorder. If I were to suddenly yell, boo, you would probably have a startle response. It would likely dissipate right away, but you also might continue to have a pounding heart, maybe become nauseous, remain on edge and even start anticipating when I might scare you again. You might also start to avoid me altogether and worry about what might happen if you get startled like that in public.

Panic disorders, recurrent, unexpected, abrupt surges of intense fear or discomfort that we call panic attacks. People with panic attacks, experience physical symptoms such as heart palpitations, sweating, shaking, shortness of breath, nausea, and dizziness. Once the panic attacks subside people often experience persistent concern or worry about additional panic attacks and their consequences, and they may also develop significant avoidance behaviors of situations, certain stimuli, and or people that they believe are associated with the attack. Social phobia is another type of anxiety disorder that involves panic attacks in social or performance situations where you feel like you might be scrutinized or negatively evaluated by others, for example, in an oral presentation in front of your class.

PTSD

While post traumatic stress disorder, known as PTSD, is no longer classified as an anxiety disorder, it still shares some symptoms of anxiety, and so I will discuss it here as well. PTSD involves exposure to actual or threatened death, serious injury, or sexual violation in which a person directly experiences a traumatic event or witnesses it in person, learns that the traumatic event occurred to a close family member or close friend, or experiences repeated or extreme indirect exposure to aversive details of the traumatic event, usually through professional duties, for example, first responders or social workers investigating child abuse.

In the case of death, the actual or threatened death would need to be either violent or accidental. The most common cause of PTSD is actually motor vehicle accidents. 

Symptoms of PTSD

Symptoms of PTSD include intrusive disturbing memories, dreams, and flashbacks. This may make it hard for students to concentrate in their waking hours.

Psychological distress and reactivity, including hypervigilance and exaggerated startle response, similar to what I illustrated when I yelled, boo. Hypervigilance means a student will stay on guard and alert, this could easily interfere with their participation in classroom activities. Persistent avoidance of thoughts, feelings, conversations, activities, places, and people associated with the trauma. Imagine a student who might've survived a school shooting that occurred on a rainy day, she might have psychological distress and not want to leave the house on rainy days.

Additional symptoms include diminished interest or participation in activities, feelings of detachment or estrangement from others, which could obviously interfere with a student's social relationships, restricted range of feelings, where the person's emotions may seem flat or robotic, and negative thinking and emotions. For example, someone who's anxious and fearful of failing or being negatively evaluated may have endless questions and requests for clarification. People with PTSD commonly have difficulty falling or staying asleep. They experience irritability or outbursts of anger, and they have difficulty concentrating.

As you can see, PTSD has a wide range of effects and can cause a great deal of disruption to college life. 

What You Can Do

There are several simple things you can do to help a student who's experiencing anxiety in the form of a panic attack, social anxiety, or PTSD. Recognize the science and get them help, put them at ease and help them to breathe or slow their breathing, reassure them and stay with them until they feel better. If a student is in the middle of a panic attack or flashback, they may seem out of it at times.

Because some people having a panic attack, especially when it's the first time, might think they're having a heart attack, it's important to take necessary precautions and call for medical help just in case.

Depression & Suicide

Suicide is a concern for students on every campus. The National College Health Assessment found:

46.4% of students reported feeling hopeless any time in the last 12 months. 62% felt very sad. 32.6% reported they were so depressed it was difficult to function. 8.1% seriously considered suicide. And 1.3% attempted suicide

Most suicidal people are suffering from depression or some other mental disorder, so along with recognizing the signs of depression, it’s also important to recognize signs of suicide.

Suicide Myths

There are many misconceptions that cloud our ability to recognize when someone is at risk for suicide so debunking myths is an important first step in suicide prevention.

The most significant one I think, because it gets in the way of assessing risk, is that asking about suicide will make someone suicidal. It’s more likely that not inquiring will cause a person to think you don’t care and they don’t matter so they might as well kill themselves.

Another myth is that most people keep their plans to themselves- but the truth is, if you ask them directly, most people will tell you they are suicidal.

You might also believe that someone won’t kill themselves if they talk about it, but that is not true. That’s why it is critical that you know how to respond appropriately when someone discloses their plans or intent.

Contrary to this last myth, there is plenty you can do to stop them once they make up their mind. We will review those actions in a moment, but meanwhile, know that suicide is the most preventable form of death.

Warning Signs

First, let’s examine some of the warning signs that someone is suicidal. There are many warning signs or indirect cues if you know what to look for:

An important red flag that should never be ignored is expressions of hopelessness. A student

might communicate hopelessness, for example, about their grades, their ability to pass or graduate, or hopelessness that their personal life will improve.

Depression is also an important warning sign. As we already reviewed, there are many signs of depression that can be observed.

Giving away prized their possessions is another warning sign. They may give away music or book collections, or favorite jewelry, for example. You will also see them getting their affairs in order, for example, returning library books or organizing their closets. A great movie that explores the issue of suicide and depicts what it looks like to get one’s affairs in order is ‘Night Mother starring Sissy Spacek and Anne Bankcroft.

As we already established, if a person talks about suicide and expresses their plans these are both important warning signs-especially if their plan is specific and they have secured a lethal means such as a firearm or have access to a lethal amount of medication, including their own antidepressant medications that have been prescribed to them to treat their depression.

Question, Persuade, Refer

To assess these warning signs and indirect cues, you can use what’s called the QPR method of suicide assessment. When you observe something that looks like a warning sign, question them: For example, you can say, “I noticed that you are giving away your favorite framed photo. What does that mean?” Or you can ask directly, “Are you having thoughts of killing or harming yourself?” It’s best to speak to them privately. Give yourself plenty of time so you are not rushed and let them speak freely. 

Based on their answers to your questions, if you believe a person is at risk for harming himself, persuade him to live, not kill himself, and to get help. Let him know that suicide is not the problem even though it is perceived as his only solution. Provide him with hope. Ask him, “Will you let me help you get help?”

And finally refer the person for appropriate help and intervention. You might have to go with them and be more involved in getting them help, so be prepared.

Suicide Crisis Intervention

In the event that the person is not just depressed, but also imminently suicidal, meaning they have a high risk of harming themselves immediately or in the next day or two, you should take immediate action. There are several resources for suicide crisis intervention and you should have these numbers programmed in your cellphone or easily accessible.

Always call 911 if you believe the danger is imminent. Many cities also have mobile crisis units of trained professionals who come on site to evaluate suicide risk. 

You can also call your campus police or security as an alternative to 911.

When the threat is not immediate, but the student would still benefit from holistic support, contact your campus behavioral intervention team if you have one. They often go by names such as CARE team, BIT, or TAT. And finally, you can call one of the national suicide hotlines to get support or to have the student speak directly to them. It’s always better to be safe than sorry, so call for help even when you are not sure if the threat is imminent.

Resources & Referrals 

Remember, your goal in learning more about mental health issues is not to get you to diagnose people or become their therapist. Your role is to help connect people in distress to the appropriate resources. In order to do this, you’ll need to understand how to make a mental health referral.

Your first line of action is 911. Always call 911 or Campus Police if you feel a student may be imminently suicidal or dangerous to themselves or others. All law enforcement and campus police are trained in handling dangerous situations. When in doubt, call anyway. Better safe than sorry!

When a student is not imminently suicidal or dangerous, make referrals and/or reports to college or community resources so they can get appropriate follow up help. Possible referral sources depend on what’s available at your college or university.

Students may also benefit from off campus resources such as a community mental health center or suicide hotline or mobile crisis unit. I recommend that you keep contact information for all of these resources handy and easily accessible.

Here are some possible resources:

Campus Counseling Office. Student Health Services. BIT (Behavioral Intervention Team). Accessibility (Disability) Services. Student Conduct Officer or Dean of Students. Department Chair. Community Mental Health Centers. Suicide Hotline.

Practice Example #1

Practice what you would say to each of these students:

You encounter a friend sitting in the hallway outside of class, crying and breathing rapidly. Your friend is trembling and looks nauseous.

“Hi. Is everything ok? Can I help you? It looks like you’re having trouble breathing. Let me call 911 ( or campus police) in case you’re having a medical emergency. Do you mind if I stay with you? Try to slow your breathing. Breathe deeply with me.”

Practice Example #2

A classmate who is usually quiet and withdrawn becomes extremely talkative, grandiose, and hasn’t slept in days.

“I’ve noticed you haven’t slept in days. Is everything ok? Has anything like this ever happened before? I think it would be a good idea to talk to someone at the counseling department or student health services. Would you like me to go with you?”

Practice Example #3

Your friend expresses a lack of interest in his usual campus activities, says he feels depressed, and can’t think or concentrate.

“What you’re describing sounds like it could be depression. I’d like to help you get some help. Would you be willing to call the counseling office for an appointment?”

Care For Yourself

Contact the appropriate campus office/department yourself to consult and make referral or get help. It can be overwhelming to support someone in a crisis or through a mental health issue. Get some support for yourself if needed.

Conclusion/Wrap-Up

Well we're at the end of the video. If any of this information struck a cord for you or reminds you of someone you know, please reach out and ask for help. There's always resources available on your campus.