Mental Health Support in Trinity College Dublin the
Mental Health Support in Trinity College Dublin, the University of Dublin Declan Treanor Director, Trinity Disability Service
International day people with disabilities 3 rd December 2018
Overview • Context, definitions, policies and data • Mental health supports in Trinity • Student Counselling • Disability Service – reasonable accommodations • Health Service • Case co-Ordinator • Transition to employment • Future directions
History of mental health in Higher Education In the last 10 years there has been 2 key strategic factors influencing where we are today 1) increase in overall student numbers 2) A strategic decision to actively seek to increase the number of students with disabilities entering higher education This has been within a general context of 1) Increased numbers of people with a diagnosed mental health condition 2) Decreased stigma around disclosing mental health difficulties
Mental Health defined • Anxiety • Depression • OCD • Borderline Personality Disorder • Autism Spectrum Disorder • ADHD/ADD – co morbidity • Other disabilities
Trinity data • 18,
Trinity data • 18, 107 students • 13, 250 Undergraduates • 4791 Postgraduates • 60% female, 40% male • 18% International • 25% students from non-traditional backgrounds (lower socioeconomic status, mature students, students with disabilities)
National and Trinity policies • Higher Education Authority (HEA) National Access Plan; • HEA Funding compacts – access measures; • HEA funding tied to numbers of students from disability groups; • HEA fund for students with disabilities; • Trinity Equality Policy • Trinity Reasonable Accommodation Policy • Trinity Accessible Information Policy
Student Supports Disability Service Academics/ Schools Case Co-ordinator Supports for Students Student Union /S 2 S Tutors Counselling Service Trinity Health Centre
Mental Health Supports in Trinity provides a suite of mental health supports, these include • Counselling, • GP and Psychiatric Supports; • Disability Service • Student Service Case Co-Ordinator – complex mental health difficulties Student Services utilises a multi-disciplinary approach, and is comprised of an experienced team of individuals who work to support students with complex disabilities.
Levels of mental health supports Psychiatry Disability Counselling
Mental Health Statistics
2018 DARE ADD Autism Blind Deaf Dyspraxia Mental_Health Neurological Ongoing_Medical Physical_Disability Specific_Learning speech Total Assessed Eligible Ineligible 271 30 340 31 50 17 105 34 334 90 635 219 142 57 507 153 173 61 1024 484 66 27 3647 1203 Total 301 371 67 139 424 854 199 660 234 1508 93 4850
DARE • The percentage of the eligible cohort accounted for by applicants with a Mental Health Condition more than doubled over the period from 2010 to 2016. Table 2. 27 Longitudinal: Eligible by disability category 2010 n % of assessed Mental Health 78 8. 2 2011 n % of assessed 112 8. 8 2012 n % of assessed 194 12. 8 2014 n % of assessed 294 12. 9 2015 n % of assessed 375 14. 3 2016 n % of assessed 512 16. 6 2017 n % of assessed 635 17. 9
National Disability Data in Higher Education
Students with disabilities
Counselling Staffing Function FTE Director 1 Administration 4 Counsellors Assistant Psychologists Sessional Counsellors Student Mentoring - S 2 S (Core) S 2 S Intern Student Learning & Development SLD 10 2 1. 4 approx 2 1 (external funding) 1. 9
Disability Service Staffing Function FTE Director 1 Administration 1 Disability Officers 1. 5 Assistive Technologists 0. 5 Occupational Therapists 3 Student Service Case Co-ordinator 1 Educational Support Workers 10 + hourly paid
Health Service Staffing Function Director - GP FTE 1 Psychiatrist 0. 6 GPs 3. 3 Nurses 2 Physiotherapist 0. 6 Administration 2 Health Promotion Officer 1
Budgets • Student Counselling € 1, 598, 000 (€ 92, 000 income generated) • Disability Service € 1, 235, 000 (all external funding) • Health Service € 1, 039, 000 (€ 289, 000 income generated) • Total € 3, 872, 000
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Student Counselling Services
Evolution of our service model Workshops Training (Staff & Students) Academic Skills Consultations Online Supports Mentors
nn e Co 4 3 2 1 s 9 rv ice er th o ct io n to 6 5 Individual Short term one-to-one counselling with a clinical professional Therapy 10 T CD S e Stepped. Care Model Connection to external, long-term clinical support / specialist care if necessary 8 7 Low to high intensity groups delivered by clinical professionals Group Therapy One-to-one appointment with a learning development expert SLD Consult Drop-in / Brief One-off support/assessment - Counselling and SLD S 2 S Peer Support One-to-one support from highly-trained fellow students Support Groups Peer based support groups for specific issues, facilitated in a safe space Silver. Cloud Online support modules with a therapist Workshops Wellbeing, Mindfulness drop-ins, Relaxation sessions, Academic skills First year undergraduate transition programme: networking, information and support S 2 S Mentor Programme Online Resources Social Media outreach, Website, Podcasts, E-Pub, SLD Blackboard module, Bibliotherapy
Trinity Disability Service
Disability transactional to transformational
Pre-entry • DARE Admissions scheme • Pre-entry orientation programme • Needs assessment pre-entry
Students register for support via their portal
Disability Service Approach
Disability Needs Assessment process • Needs Assessment = 1: 1 appointment with Disability Officer • Elements of needs assessment: - Educational background - Disability information - Course demands discussed / Student concerns - DS Supports and Reasonable Accommodations available - Confidentiality and Disability Disclosure - Communication about LENS report
Mental health Needs Assessment • Ask about the student’s wellbeing since their evidence of disability was completed, any changes to their health, treatments or supports, changes in medication, periods of hospitalisation or additional diagnosis. • Ask if they have any other disability or medical condition not already disclosed. • Ask the student to advise whether they are in receipt of external support/treatments for their disability, how often they are meeting this support, where the support is based and will it impact on their studies if the student needs to attend appointments. • Ask about their family supports and if there any factors that may negatively impact on their ability to meet their course requirements.
Reasonable Accommodations • A Reasonable Accommodation is any action that helps to alleviate a substantial disadvantage due to a disability and/or a significant ongoing illness. • Reasonable accommodations are determined at a Needs Assessment on a case-by-case basis and in accordance with the individual's certified disability/specific learning difficulty. • Examples: - Allow student an alternative assessment mechanism - Allow student to split modules over a number of years - Flexibility on attendance / deadlines
Standard / Non-Standard Reasonable Accommodations: • Have been RAs that generally can be implemented by schools / disciplines at a local level * Non-Standard Reasonable Accommodations: • Have been RAs that have required communication with departments, either from DS or through tutor system. • Standardisation of process of collaboration with department in decision making • * If concerns regarding standard accommodations that may impact the academic integrity, then can be addressed through the non-standard route.
Reasonable Accommodation Examples • • • Exam Accommodations – low distraction, prompts, extra time Use of AT within learning settings Flexibility on assignment deadlines Flexibility on attendance for modules, tutorials etc Placement specific reasonable accommodations Rest breaks – respite room Additional Library supports Additional time to develop practical skills Accommodation on campus Erasmus and career focused supports
Mental Health Occupational Therapy Support 1. The OT support process based upon the tool called the Trinity Student Profile 2. Based upon the Person Environment Occupation model (Law et al. , 1996)
Health – mental health supports • GP – 17, 000 students appointments annually – 7, 000 are Mental Health Related , (Acute Stress Reactions, related to, Exams, Relationship Difficulties, Bereavements, Family Issues and Stresses around Finance or Accommodation) • Referral to Psychiatrist internal or external • 18 -18 new patients per month (200 annually) • 2 students attend ADHD Clinic • 30 return patients monthly (30 min appointments) • I patient referred every 2 months voluntary admissions, 1 involuntary annually • Waiting time to see Psychiatrist – 4 weeks • Referral to Case co-Ordinator for transition or management
Joined up thinking – Case Co-Ordinator role • In December 2017 Trinity College Dublin (Trinity) became the first third level institute in the Republic of Ireland to employ a Mental Health Case Coordinator to specifically work with students with complex mental health difficulties • Trinity has noted the year-on-year increasing trend of students registering with the Disability Service with a mental health diagnosis • This year mental health was the single largest disability category (361 of 1551 students with disabilities in Trinity or 25% of total of new entrants in 2017 -18) registering for Disability supports in Trinity. • The findings from ‘Mapping best Practice in Higher Education’ in Ireland discussed how some University’s Student Services seemed to operate within “silos
Referral to Case Coordinator Receive Referral from DS, College Health, Student Counselling Receive Referral from University Psychiatrist Assess referral Record referral details Consult as appropriate Arrange CC/Student appointment. Consult as appropriate Case Co-ordinator & student meeting Collaborative Planning Intervention Planning & Individual work Onward Referral either Internal or External Update the referral source database Attend Case Management Meetings in the Disability Service Attend Student Counselling Service Attend OT/University Psychiatrist
Fitness to study & Fitness to Practice The University is committed to supporting and responding to student needs, seeking to ensure a positive student experience, and promoting opportunities for students to develop to their full potential. This Fitness to Study Policy is intended to be used to respond to and manage concerns regarding a student’s fitness to perform all activities associated with attending College, and/or concerns regarding a student’s capacity, and/or concerns regarding a student’s mental health.
Fitness to Study ‘Note of Concern’ received Spreadsheet Consult with the Dean of Students Fitness to Study Advisory Group Secretary to Fitness to Study Advisory Group Level 1 Level 2 Level 3 Receive Agreed Action Plan Arrange to meet Relevant Person Implementation Plan to include Communications Review DB/
External Liaison role • The mental health services in Ireland are under severe pressure. Waitlists are ever increasing. Community mental health services are often firefighting and understandably they are trying to only see those most in need. From a College perspective, we too are trying to prioritize our own referrals • Generally, students who are ordinarily resident in Dublin can avail of their catchmental health services – the Case Coordinator can liaise with these services if needed • While at times it may not easy to access mental health services, accessing services for international students and students from counties other than Dublin is particularly difficult – the Case Coordinator job is to try and make this process more effective
External liaison • Many students availing of the DARE admission scheme (Disability Access Route to Education) will have had a history of regular interactions with CAMHS (Child & Adolescent Mental Health Services) • Research by Mc. Namara et al (2014) highlighted the difficulties in planning transitioning from CAMHS to adult services in the Republic of Ireland • Trinity are liaising with the Irish University Association to try and improve this transition from CAMHS into adult services so students are already engaging in adult services before commencing University
Fitness to Study • 'Fitness to Study' policy. The philosophy of the policy is to support students with fitness to study difficulties in as positive a manner as possible. The role of the Case Coordinator will also involve supporting all stakeholders in any fitness cases, reviewing & updating existing policies • Medical repeat decision making group • International Students in Crisis Policy & the Mental Health Policy.
Crisis management • There are many times when students present to services in crisis. This can be in any area of college such as to academic staff, admin staff or Student Services • The role of the Case Coordinator is to assist in these crises and to manage, coordinate and follow-up on these cases
Into employment
Transition from College to Workplace • How can I decide if I want to disclose what ‘Reasonable Accommodations’ I might need to my new employers? • How can I go about organising ‘Reasonable Accommodations’ with my new employers? • Do I think there might be advantages/disadvantages and how would I like to manage the potential situations that I will be in?
Future directions • Likely Counselling, Disability and Health will merge supports to offer a more defined service model for students with mental health difficulties; • Numbers of students in these cohorts will continue to increase so supports will need to constantly change and be reviewed to ensure fit for purpose; • Students with complex mental health difficulties will increasingly be in University and will need refined supports – internal and external;
Useful resources
Useful resources Autism
Useful resources – UD Learning
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