CPD 21 Advanced Teaching Skills 3 Supporting Students

CPD 21 Advanced Teaching Skills 3 Supporting Students Well Being University of Manchester Counselling Service Sarah Littlejohn Head of Counselling Service sarah. littlejohn@manchester. ac. uk www. manchester. ac. uk/counselling Sarah Littlejohn 2014

Context • The University is a community of over 50, 000 students and staff with commensurate psychological needs and difficulties and with particular challenges and demands. • In the general community between 15 - 20% of people report mild to moderate mental health difficulties at any one time (ONS 2000 Study of Psychiatric Morbidity). • In the general population reported rates for moderate to severe mental health problems run at 10% and severe and persistent at 2. 5% (ONS 2000 Study of Psychiatric Morbidity). Sarah Littlejohn 2014

Developmental Issues • Age of rapid psychological and emotional developments and demands • Identity still forming or for older students established identity can be under pressure from competing demands • Expectation of self reliance and robustness – move to independence and autonomy or maintenance of it • Not coping is hard to acknowledge • Mal adaptive coping strategies frequent and common in this age group Sarah Littlejohn 2014

High Zubin& Spring (1977) Model of Stress Vulnerability ILLNESS Stress WELLNESS Low Vulnerability Sarah Littlejohn 2014 Hig h

Possible causes of crisis Think about the student population • What could push someone from struggling to cope into a crisis? • Are there any particularly vulnerable groups of students who are at risk of finding themselves in a crisis situation? Sarah Littlejohn 2014

Potential precipitants Academic pressures Alcohol or substance use Pre-existing mental health problems: worsening symptoms, relapse, lack of appropriate support Isolation Financial stress Crisis Transition/ significant changes in life Sarah Littlejohn 2014 Relationships Balancing different responsibilities

Small group task • How might you become aware of a student in difficulty? Sarah Littlejohn 2014

Mental Health and the Student Population • 80% adults with depression experience their first episode before age 18 • 18 -25 yrs is key risk period for development of serious mental illness –e. g. psychosis • Even milder levels of distress and disability can impact significantly on functioning • University community can be considered a protective factor (RCPsych 2011, DH 2011) Sarah Littlejohn 2014

A student suffering from mental health problems may • Show decline in performance • Seem more withdrawn, apathetic and avoidant • Show high levels of anxiety, indecision and distress which cannot easily be explained or resolved by discussion • Be irritable or snappy • Experience changes in sleep or appetite • Feel that things are somehow different • That their thoughts are speeded up or slowed down • Prefer to avoid contact and help and be unrealistically afraid of or suspicious of your or others care or concern • Be reported by others as showing odd or changeable behaviour and moods Sarah Littlejohn 2014

Cont… • They may give rise to anxiety and concern in yourself which is confirmed by others and by friends, flat mates or family members • Show evidence of crisis coping through misuse of drugs or alcohol • Seem physically ill or neglected • Be the cause of disciplinary action or complaint which cannot be resolved or is not acknowledged • Report or be reported as not studying or be without motivation or usual interests Sarah Littlejohn 2014

Suicide • Among 15 -34 year olds, suicide is one of the three main causes of death worldwide (Bertoloteet al. , 2003). • 50% of all people who commit suicide will have had previous contact with mental health services. • 25% of all people who die by suicide have had contact with mental health services in the year before death (Appleton, 2000). Sarah Littlejohn 2014

The most important risk factors • • • Recent history of suicidal behaviour Family/close friend history of suicide Ideas of suicide Intent to commit suicide Access to lethal means Sarah Littlejohn 2014

Be Direct • • • How are you feeling? What's the worst that it gets for you? Have you felt like this before? What are you going to do now? What exactly do you mean by not wanting to be here? When you feel at your worst do you ever feel like you don’t want to be alive. Sarah Littlejohn 2014

• It is very important that your questions should enable you to answer these questions • Are there thoughts about suicide? • Is there any intent to commit suicide? • Is there access to lethal means? Sarah Littlejohn 2014

Worried? • What to do when you are concerned for a students safety. • Ask • Discuss with others –colleagues, CS etc • Refer/accompany – within Uni or outside • OR emergency services • Follow up Sarah Littlejohn 2014

Early engagement • You may be approached by the student themselves, by others concerned about the student or you may need/decide to approach the student yourself. • The difficulty may be brief and mild, brief and acute, enduring and mild or enduring and acute • Determined by the impact on the student – not an objective measure – e. g. risk of being experienced as dismissive Sarah Littlejohn 2014

Setting the scene • Boundaries and limits – Time, space, role, level of involvement • Nature of and limits to confidentiality – Discuss. • Engagement – Welcome, warmth, interest, attention • Ending and limits – Keep to agreed time, unless very good reason, be aware of limits to your role and pull to offer more/less Sarah Littlejohn 2014

What is going on? • Active listening – Reflection – Open questions – Paraphrasing – Non-verbal communication Sarah Littlejohn 2014

Non verbal communication • Open gestures. Hands open and slightly out • Intermittent eye contact – too direct and it can feel like a challenge, too avoidant and it can feel like you are not listening • Soft tone, slow down, open face, relaxed muscles. Sarah Littlejohn 2014

Finding a focus • • • What's the central issue Closed questions Summarise Agree a consensus description The miracle question Sarah Littlejohn 2014

Reflect the story back to them • Summarise – “Let me make sure I've got this right…” “Let me see if I've understood…” “So from what I hear…. ” • Check for signs of agreement or hesitancy. • Be aware that when vulnerable we can find it hard to challenge or disagree Sarah Littlejohn 2014

Making a plan • • • Information, resources, referral What are the obstacles to action Pros and cons of action Timescale Follow up/further support Sarah Littlejohn 2014

What can we do now? • Problem solving – “Lets see what we can work things out”, “I want to try to see if we can think through what to do now” “I understand how difficult this is for you and it may be that we can’t fix it but lets see what the next step could be” • Be aware that we will have our own coping patterns/solutions. Eg striving, internal critic, Sarah Littlejohn 2014

Academic pressures Build up Avoiding overlooking Demanding Critical Strive, Cope alone Anxious Inadequate Avoid Too much Safe but cut off, daydream Sleep etc Reinforces lack of agency I can’t cope, Overwhelmed, panicked Seek rescue, Powerful Rescuing Controlling Helpless, needy dependant Sarah Littlejohn 2014

Solving the problem • Can collaboratively generate lots of small changes that address the problem • Can be psycho-educational, skills based • Study skills, time management etc • Solving the particular problem • These might be seen as within your role – with the focus on academic performance. Sarah Littlejohn 2014

Form study group, praise, Mini breaks, rewards Demanding Critical Strive Cope alone Anxiously unsure Talk to department Academic pressures Build up Talk to others Too much Relaxation files Safe but cut off Daydream Sleep etc Honest review Mini deadlines Reinforces lack of agency I can’t cope, Overwhelmed, panicked Take mini control Avoiding overlooking Seek rescue Powerful Rescuing Controlling Helpless dependant Sarah Littlejohn 2014 Set DIY tasks

Referral • When the problem persists – it may have an underlying psychological cause – e. g. mal adaptive coping – avoidance, striving, perfectionism • When the problem is more clearly psychological/emotional • When the problem seems to be psychiatric/medical Sarah Littlejohn 2014

Internal sources of help • • Within School – student support Counselling Service Disability Support Office Atrium -IAG Security Occupational Health Wardens/tutors Mental Health Policy Sarah Littlejohn 2014

External sources of help • G. P • A&E • Emergency Services Sarah Littlejohn 2014

Helping roles • Key patterns can play out in any helping relationship • The response of those involved in helping play a key role in maintaining or changing problematic behaviours or patterns • The more intense a relationship the more powerful these responses are likely to be Sarah Littlejohn 2014

Common themes • Common unhelpful themes of emotional response in helpers are – Rescue – Avoidance/withdrawal – Hostility/irritation Sarah Littlejohn 2014

Rescue • In which you become aware of feeling anxious and responsible. • You feel burdened and the other seems needy • Usual boundaries become stretched or blurred • The other becomes overly reliant and not seeking appropriate help elsewhere Sarah Littlejohn 2014

Avoidance/withdrawal • In which you are aware of dreading the contact • You feel disengaged, tired, distracted when with them • You do not address clear difficulties and avoid naming the obvious Sarah Littlejohn 2014

Hostility/irritation • In which you feel resentful and frustrated • Find yourself having critical and angry thoughts about them • Are short or brusque Sarah Littlejohn 2014

Who feels what? • These common responses are reported across profession and context • They are partly elicited by the student • Partly informed by our own interpersonal style • Important to be aware of these internal responses even if not acted on • Will help appropriate responses Sarah Littlejohn 2014

Counselling Service • We offer confidential help with any personal issues affecting work, self esteem, relationships, mental health or general well being. • Groups and workshops • We offer a phone consultation service – contact us if you are worried about a student or unsure how to resolve an issue. • Programme of mental health and risk training offered by our service • Psychiatric and mental health nurse • We liaise with NHS mental health services in relation to students with complex or acute difficulties Sarah Littlejohn 2014

• Individual counselling is usually brief, focussed and time limited. Most clients attend for 1 -4 sessions, although there is scope for longer term work. • We have good links with other external agencies, and can refer on when appropriate • Sometimes it is more helpful for clients to attend part of our group work programme Sarah Littlejohn 2014

Groups Programme • • • Managing Low Mood Managing Anxiety Mindfulness Actively Managing Your Mood Managing Sleep Problems Managing Academic Pressure Making the change: settling in Confidence and Self-Esteem Group Managing exam Stress Managing your relationship with your supervisor Tailored help for specific client groups or problems Sarah Littlejohn 2014

Self help on our webpages • On-line resources –Silver Cloud programme, self help modules on stress, low mood, anxiety and sleep problems. • Audio files – anxiety reduction, mindfulness, sleep, exam stress. • Details of self help books, held for us in the university library. Sarah Littlejohn 2014

After thoughts • Helpers role is implicitly and unavoidably emotional and relational • This may be its main but noticed reward • Representing a certain quality of human relations as a peer for the individual and the organisation Sarah Littlejohn 2014

Contact Us • 5 th Floor Crawford House, Booth Street East • 0161 275 2864 • Counsel. service@manchester. ac. uk • www. manchester. ac. uk/counselling Sarah Littlejohn 2014