Other mental health concerns include but are not limited to the following: eating disorders, self-harm, panic attacks, and depressive episodes. For suicide attempt and suicide ideation, see those protocols. When responding to any mental health concerns, utilize the following model to guide the conversation with the resident:
| A | Assess for risk of suicide or harm |
| L | Listen non-judgmentally |
| G | Give reassurance and information (i.e. refer to campus resources) |
| E | Encourage appropriate professional help |
| E | Encourage self-help and other support strategies |
Immediate Action: RA notifies Pro-Staff On-Call.
Secondary Action: Pro-Staff On-Call responds to the scene to speak with the resident. While waiting for Pro-Staff, RA can begin a wellness check conversation with resident.
Third Action: Pro-Staff On-Call speaks with the affected student and works to assess whether immediate medical attention is needed (see Assessing Mental Health Concerns below).
● If so, notify UCPD/CPD and enact Medical Transport protocol.
● If not, refer the student to the appropriate campus resource(s)
Fourth Action: Pro-Staff On-Call checks on responding RA and any other impacted individuals (i.e. roommates) to evaluate if any after-care or referrals are needed.
Reporting Action: RA and Pro-Staff On-Call documents the situation with an incident report. Pro-Staff submits a CARE Report.
Assessing Mental Health Concerns
The following information is from Mental Health First Aid, a resource of the National Council for Behavioral Health and the Missouri Department of Mental Health.
Anxiety
Symptoms of anxiety affect physical well-being, thoughts, and behavior. Some examples are as follows:
● Physical
○ Pounding heart, chest pain, rapid heartbeat, flushing, hyperventilation, shortness of breath, dizziness, headache, sweating, tingling, numbness, choking, dry mouth, stomach pains, nausea, vomiting, diarrhea, muscle aches and pain (especially neck, shoulders, and back), restlessness, tremors and shaking, inability to relax.
● Thoughts
○ Unrealistic and/or excessive fear and worry (about past and future events), mind racing or going blank, decreased concentration and memory, indecisiveness, irritability, impatience, anger, confusion, restlessness or feeling “on edge” or nervous, tiredness, sleep disturbance, vivid dreams.
● Behavior
○ Avoidance of situations, obsessive or compulsive behavior, distress in social situations, phobic behavior.
A panic attack is a distinct episode of high anxiety with fear or discomfort. It develops abruptly and has its peak within 10 minutes. During the attack, several of the following symptoms are present:
● Palpitations, pounding heart, rapid heart rate
● Sweating
● Trembling and shaking
● Shortness of breath, sensations of choking or smothering
● Chest pain or discomfort
● Abdominal distress or nausea
● Dizziness, light-headedness, feeling faint or unsteady
● Feelings of unreality or being detached from oneself
● Fear of losing control or “going crazy”
● Fear of dying
● Numbness or tingling
● Chills or hot flashes
If a student is experiencing symptoms of a panic attack, ask the student the following:
● Do they know what is happening, or
● Have they previously had a panic attack and believe they are having one now, and
● What help do they need?
Symptoms of a panic attack can mimic that of a heart attack. Only trained medical professionals can evaluate the difference. If the student has not had a prior panic attack and doesn’t believe they are having one now, alert UCPD/CPD for medical assistance.
Depression
Symptoms of depression affect emotions, thinking, behavior, and physical well-being. Some examples are as follows:
● Emotions
○ Sadness, anxiety, guilt, anger, mood swings, lack of emotional responsiveness, feelings of helplessness, hopelessness, irritability.
● Thoughts
○ Frequent self-criticism, self-blame, worry, pessimism, impaired memory and concentration, indecisiveness and confusion, a tendency to believe others see you in a negative light, thoughts of death and suicide.
● Behavior
○ Crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation, slowed down, using alcohol or other drugs.
● Physical
○ Chronic fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, headaches, irregular menstrual cycle, loss of sexual desire, unexplained aches or pains.
Disordered Eating
Eating disorders have a wide range of symptoms and warning signs that impact behavior, thought, and physical well-being. However, the symptoms listed below indicate that there may be a physical health crisis requiring immediate treatment:
● Disordered thinking and not making any reasonable sense (a person who is malnourished may appear to have psychotic symptoms such as disordered thinking, delusions, or hallucinations)
● Disorientation, doesn’t know what day it is, where they are, or who they are
● Vomiting several times a day
● Fainting spells
● Collapses or is too weak to walk
● Painful muscle spasms
● Chest pain or trouble breathing
● Blood in their bowel movements, urine, or vomit
● A body mass index of less than 16
● An irregular or very low heartbeat (less than 50 beats per minute)
● Cold or clammy skin indicating a low body temperature or a body temperature of less than 95°F
Psychosis
Psychosis is a general term used to describe a mental health problem in which a person has lost some contact with reality, resulting in severe disturbances in thinking, emotion, and behavior. Common symptoms that indicate psychosis is developing:
● Changes in emotion and motivation
○ Depression; anxiety; irritability; suspiciousness; blunted, flat, or inappropriate emotion; change in appetite, reduced energy and motivation.
● Changes in thinking and perception
○ Difficulties with concentration or attention; a sense of alteration, such as the feeling that they or others have changed or are acting differently in some way; odd ideas; an unusual perceptual experience, such as reduction or greater intensity or smell, sound, or color.
● Changes in behavior
○ Sleep disturbances, social isolation or withdrawal, reduced ability to carry out work or social roles.
Psychosis may indicate that a person is suffering from schizophrenia or bipolar disorder.
Self-Harm
● Self-harm may include, but is not limited, to the following behaviors:
● Cutting, scratching, or pinching the skin enough to cause bleeding or a mark that remains on the skin
● Banging or punching objects to the point of bruising or bleeding
● Ripping and tearing skin
● Carving words or patterns into the skin
● Interfering with the healing of wounds
● Burning skin with cigarettes, matches, or hot water
● Pulling out large amount of hair
● Deliberate overdosing on medication when this is not meant as a suicide attempt.
○ Immediate medical attention is necessary if the individual has taken an overdose of medication or consumed poison.
CPD/UCPD should be notified if a person that is engaging or has engaged in self-harming behavior is confused, disoriented, unconscious or has bleeding that is rapid or pulsing.