Faculty and Staff Guide for Supporting Students in Distress

Understanding the Student Experience

Some students may have hesitations around attending counseling or receiving help/support. It is always helpful to ask the student what they think of counseling. Never assume what barriers a student is facing – the information below may not apply to all students who hold these identities. Understanding a student’s background (e.g., culture, family, academic track, multiple social identities) can help you understand struggles they may be facing and ways in which you can support them most effectively.

First-Year Student: New geographic location, roommate relationships, transition to college, navigating independence, living on their own for the first time.

Graduate/Professional Student: Additional responsibilities, autonomy, financial considerations, impostor syndrome, isolation, parenting and caregiving.

Non-Traditional Student: Readjustment to academic setting, finances, worry about succeeding, developing an on-campus community.

Transfer Student: Adjusting to ETSU, transition to a new setting, building community, feelings of belonging.

Student Veteran/Military-Connected: Adjustment to civilian life, experiences of trauma, stigma around help-seeking.

First-Generation Student: Culture shock, possible lack of support or understanding from family, pressure to succeed.

International Student: Cost of tuition, uncertainty around jobs and visa situation, culture shock, language barriers, homesickness, challenges or inability to return home for the holidays.

Low SES Student: Lack of fallback option or safety net, financial considerations, guilt associated with attending school, travel costs during breaks/holidays.

Students of Color:Lack of representation and diversity on campus. Feeling like the
“only one” in the classroom which may increase pressure to represent an entire group and be the group’s spokesperson. Impact of micro-aggressions and macro-aggressions.

Students with Diverse Religious/Spiritual Beliefs: Navigating the academic calendar with religious holidays, lack of representation, micro-aggressions and macro-aggressions, not knowing if there are safe spaces to practice/express beliefs.

Gender Non-Conforming, Non-Binary, Trans Students: Navigating use of pronouns and names, self-expression, establishing community and support, micro-aggressions and macro-aggressions.

Students with Diverse Sexual Orientations: Development of identity while navigating academic and life demands, self-expression, establishing community and support, microaggressions and macro-aggressions.

Students with Visible and Invisible Disabilities: Navigating campus and classroom environments that may not accommodate neurodiversity (e.g., ADHD, autism spectrum, learning disabilities, etc.); challenges with navigating physical environments and/or course material accessibility; sensory, psychological and emotional challenges; physical disabilities; chronic health conditions.

Warning Signs

Not all students will show distress in the same way. This section lists potential indicators that a student is struggling. Please keep in mind that this list is not exhaustive and that other signs may present instead.

Risk Guide for Responding to Students of Concern

Low Risk - Mental health concerns without the risk of suicide

• Anxiety/panic attacks
• Relationship concerns / Break-up
• Eating concerns
• Self-injurious behaviors without suicidal thoughts
• Passive suicidal thoughts (“I can’t do this anymore”), helplessness, hopelessness

If Low Risk, submit a CARE Report. Provide information on campus resources.

Moderate Risk  - Physical safety is not an immediate concern but professional support is needed to prevent escalation

• Suicidal thoughts but student is currently safe and is help-seeking
• Recent sexual assault or domestic violence
• Recent death of a loved one

If Moderate Risk, encourage the student to call BucsPress2 at (423) 439-4841 and press 2 to speak with a licensed provider OR offer to walk with the student to the Counseling Center for support (if during business hours).  Submit a CARE Report for additional support.

High Risk

• Imminent threat of suicide / Suicide attempt
• Student is unresponsive to outside stimuli or is disconnected from reality
• Alcohol or drug overdose

Risk to Others

• Mental/emotional state is disruptive to the learning environment Homicidal intent/attempt
• Unprovoked anger or hostility/physical violence
• Stalking or harassment of others

If High Risk or Risk to Others, contact Public Safety at (423) 439-4480 for immediate assistance. In situations where phone calls cannot be completed, you can alternatively press the “Emergency Phone Call” button located in the ETSU Safe app.

If unsure of the level of risk present and/or if your concern is more pressing, you can contact the Counseling Center at (423) 439-3333 or the Dean of Students office at (423) 439-5377 to consult. Please note that students may decline professional intervention unless criteria for emergency detention or involuntary hospitalization are met.

Tips for Supporting a Student in Distress

It is impactful to simply listen, show care, and offer resource information. You do not need to be a counselor to be helpful to a student who is struggling.

DO

• Meet privately with the student
• Choose a time/place where you will not be interrupted
• Set a positive tone and express your concern
• Try to focus on an aspect of the problem that is manageable
• Point out specific signs you’ve observed
  • “I’ve noticed lately that you...”

YOU MIGHT ASK

• “I’ve noticed you haven’t been attending class regularly, are you okay?”
• “I’ve noticed you’ve seemed a little down lately, so I wanted to check in with you. What’s been going on?”
• “I noticed you missed class a few times. What’s going on for you?”
• “You seem really tired in class lately. How are you doing these days?” 

WAYS TO RESPOND

• “I’m so glad you told me about this. Let’s brainstorm how we can get you some support.” “Thank you for sharing this with me. There’s good support on campus—I’ll help connect you to someone who can help.”
• “Wow, that sounds really hard. It makes sense you are struggling. Let’s figure out what on-campus supports can help you right now.” 

WAYS TO TALK WITH A STUDENT THAT MAY NEED IMMEDIATE HELP

• “I understand that you are hurting right now. I am here to help you and connect you to good support on campus.”
• “I hear that you feel hopeless right now. I’ve worked with the counseling center, and I think they could help. Let’s walk over together.”
• “I can tell that you’re very upset, and I’m concerned about you. I’m going to connect you with someone who can help you stay safe.”

REMEMBER TO

• Ask, “How are things going for you?” Listen attentively to the student’s response and encourage them to talk. “Tell me more about that.”
• Restate what you have heard as well as your concern and caring. Ask the student what they think would help. “What do you need to do to get back on track?”
• Suggest resources and referrals. Share any information you have about the particular resource you are suggesting and the potential benefit to the student. “I know the folks in that office and they are really good at helping students work through these kinds of situations.”
• Unless the student has active plans to end their life and cannot keep themselves safe or may be a danger to others, the ultimate decision to access resources is the student’s. If the student says, “I’ll think about it,” when you offer referral information, it is okay.
• Let the student know that you are interested in hearing how they are doing in a day or two. End the conversation in a way that will allow you, or the student, to come back to the subject at another time. Keep the lines of communication open.
• File a CARE Report. 
• Autonomy is key. The student must be the one to seek out services and contact the Counseling Center. We cannot contact them or mandate treatment.

Students with Suicidal Thoughts

WHAT YOU CAN DO

• Listen carefully and validate the student’s feelings and experiences.
• Express your genuine concern for the student, focusing on specific behavior and/or changes you’ve observed (e.g., irregular class attendance, deteriorating academic performance, marks on their arms).
• Allow the student to respond to your concerns and observations.
• Encourage the student to use positive coping strategies to manage transition stress, including regular exercise, use of social support, a reasonable eating and sleeping regimen, and scheduling pleasurable activities. (“Tell me what you have done in the past that worked when things have been tough.”)
• Listen carefully and validate the student’s feelings and experiences. (“It must be very difficult, tiring, and distressing to feel this so often.”)
• Recommend that the student consult with a counselor about their experiences.
• Be willing to consider flexible arrangements (e.g., extension on a paper or exam), if appropriate, as a way to alleviate stress and instill hope.
• Project a calm demeanor, although this is not how you may be feeling on the inside. The modeling of calm behavior is very important for the student, as they are looking to you for assistance.
• Be very straightforward and know that your question is not going to cause them to act on their suicidal thoughts. In fact, suicidal students usually want to communicate their feelings. Possible ways to phrase the question include,
  • “I can see this is a difficult time for you. Are you having thoughts of hurting yourself?”
  • “I am concerned for you. Have you been thinking of ending your life?”
  • “Are you considering suicide?”
• Practice how you might ask this question if the situation arises. It can often be hard to ask if you’ve never done it before.
• Know what your options are, and what your next steps will be, depending on how the student answers.
• Refer student to the Counseling Center. It may be beneficial to walk the student over to the center. If it is after business hours or if the student does not wish to come to the Counseling Center, students can be connected with BucsPress2 [(423) 439-4841, press 2].

WHAT IF THE STUDENT REFUSES HELP?

If the student refuses help and you are still concerned, there are several options:

• It is never a bad idea to submit a CARE Report about your interactions with a student or your concern about a student. https://www.etsu.edu/bucscare/report.php
• Share information about BucsPress2. The Counseling Center has flyers, cards, and other resources if you are interested in having some in your office.
• Request a Wellness Check. This involves Public Safety coming to the student’s residence. Reserve this for situations where you are worried for the student’s physical safety and evidence suggests the student may harm themselves within a short period of time (e.g., cannot wait until business hours at the Counseling Center). 

Mental Health Concerns & Academic Performance

Because students may face academic difficulties when they are struggling with their mental health, faculty may receive communication from students regarding their course.

As a faculty member, it is important to encourage students to be proactive in communicating with you and in seeking professional support when concerns arise. If students anticipate poor performance in a course (often toward the end of the semester), it is not uncommon for a student to reach out via email citing their mental health as a contributing factor. Sometimes, but not always, requests may accompany these communications.

Specific requests may range widely but could include:

1. An extension on an assignment
2. Delaying or retaking an exam
3. Flexibility with the attendance policy
4. Course accommodations related to a documented disability (e.g., psychiatric diagnosis)
5. Academic appeals following a semester of poor performance

Please keep the following resources in mind when these circumstances arise.

Office of Disability Services If students are requesting specific accommodations on the basis of their mental health, the Office of Disability Services can work with students to gather the necessary documentation to support this request.  

Dean of Students  If the student has been hospitalized for mental or physical health concerns or the University has learned of extenuating circumstances that may impact the student’s ability to effectively engage in their courses, the Dean of Students office may notify faculty members to alert them of the student’s concerns. The Dean of Students office can work with students to identify what form of support may be needed and create an academic plan, which could include requesting incompletes, withdrawing from specific courses, or withdrawing from the university, depending on the nature of the concern.

Counseling Center  If a student is citing their mental health as the primary barrier to their academic success, it is helpful to know how/if the student is taking the appropriate steps to address their concerns. Students may report that they are currently being seen at the Counseling Center. If so, the Counseling Center will provide a treatment summary, including professional assessment of how their mental health may be impacting their academic performance. Please note that sometimes students will attend one appointment at the Counseling Center for the purpose of documentation but will not be engaged in care. In these instances, the Counseling Center will typically only provide a printout of attendance history, with no letter of support. These two distinct forms of communication will assist the faculty member in evaluating the legitimacy of the student’s request.

Faculty members should always assume the student is being honest regarding their distress. That said, it is reasonable to request documentation of these concerns through one of the channels above prior to making a determination regarding next steps.

Responding to Disruptive Student Behavior

Establishing norms helps prevent disruptive behavior and allows you to react effectively in the moment. In addition to using your syllabus to set academic expectations, you can also utilize it to create classroom behavioral expectations. The factors that constitute appropriate and inappropriate behavior are often dependent on the nature of class and faculty comfort level, and can vary widely from lectures to labs and across content areas.

Faculty have found it helpful to:

• Outline both productive and disruptive types of behavior.
• Outline the process by which disruptive behavior will be addressed.
• Outline consequences for ongoing disruptive behavior.
• Verbally address classroom expectations regarding behavior on the first day of class. It is especially effective to talk about behavior you want to see, as well as the type that’s disruptive.
• Model the type of behavior you expect from your class.

If you find yourself working with a disruptive student, consider the following:

• Talk to the student in a place that is safe and comfortable.
• Remain calm and take the lead. (“Tell me what is bothering you and then let’s decide what solutions there might be.”)
• Set clear limits up front and hold the student to the allotted time for the discussion. (“I have 10 minutes today, and so within that time, what can I try and help you with?”) Emphasize behaviors that are and aren’t acceptable. (“If you want me to continue with this, I will need you to be as respectful of me when you are talking as you would want me to be respectful of you.”)
• Respond quickly and with clear limits to behavior that disrupts class, study sessions or consultations.
• Be aware of the potential for manipulative requests and behaviors. (“You came asking for my help and I have offered you several ideas, but they do not seem to work for you. What ideas do you have?”)
• Maintain a voice quality that is matter-of-fact, monotone.
• Use clear, assertive statements of consequences; repeat as necessary.
• Use eye contact sparingly — only to emphasize a point.
• If you feel it is appropriate to continue meeting with a distressing/aggressive student, remain in an open area with a visible means of escape (keep yourself at a safe distance, sit closest to the door and have a phone available to call for help).
• Use a time-out strategy (ask the student to reschedule a meeting with you after he/she has more time to think).
• Enlist the help of a co-worker (avoid meeting alone or in a private office with the student). Assess your level of safety and be cognizant of your intuition. Call Public Safety if you feel the student may harm themselves, someone else, or you.Seek input and support from the Dean of Students office. 423-439-5377.

Suggestions for intervention during class

• Keep your focus on the student. Rather than say, “Class, we all know that talking during lecture is disruptive,” say, “Jane, your talking during class is disrupting the lecture and I need to ask you to stop.”
• Be clear about the behavior. If the student is talking out of turn, tell them. Rather than ask, “Do you have a question?” say, “Jane, now is not the time for discussion. There will be an opportunity for questions and debate at the end of the lecture.”
• Nip the situation in the bud, referring to the syllabus regarding expectation and behavior. “Jane, you will note that in the syllabus, talking during lecture is considered disruptive behavior. If I need to ask you to stop talking again, I will need to ask you to leave.”
• Distress is often the cause of a disruption. It is important to recognize the stress while still addressing the behavior. Rather than say, “John, you are clearly emotional right now and you need to stop arguing,” say, “John, I can see that this topic has you upset; however, we need to bring this debate to a close.”
• If you need to ask the student to leave, do so clearly and directly. Rather than say, “Get out! Go! Get out of here!” say, “John, your behavior has exceeded what is acceptable for this class and it is time for you to leave. I will be in contact with you via email to discuss future class sessions.” At this point, it is a good idea to pause class until the student exits the room.

What to do following a disruption

While many disruptions are minor and can be managed in the moment, it can be beneficial both to document the incident and follow up with the student. Documenting what you experienced and the steps you took will be helpful if you need to pursue a violation of the student conduct code. Clear communication with the student helps to set expectations and prevent further disruption.

The following are suggestions to consider following an incident:

• Document the details about the incident, including the time/date/location, the behavior of the student, the actions you took and how the situation was resolved in the moment. Send this information to the Dean of Students office if you would like further review of the matter.
• For minor disruptions, an email can serve as both a tool to remedy behavior and to document the incident. In the email, you should include the observed behavior, your expectations for class and how they differ from the observed behavior, and the consequences of continued disruption.
• If the disruption is more egregious or a behavior is ongoing, you should contact the Dean of Students office for appropriate next steps. Keeping them in the loop regarding behavior of concern is always recommended.
• In some cases, a meeting with the student is warranted. The Dean of Students office can support or lead this meeting, either inside of outside of a conduct process.

Identifying Disturbing Writing

Not all disturbing writing leads to violence. Not all writers or creators of disturbing work tend to act violently (e.g., Goethe, Edgar Allen Poe, Anne Rice). Students often use their journals and writing assignments to work through their problems and explore their imaginations. This is similar, in many ways, to children who act out their violent fantasies through play. Horror movies and fiction are an accepted part of American culture. Many students who write about violence may simply be mimicking what they are exposed to in society.

Questions to Ask Yourself

• Does the violence occur appropriately within the context of the subject matter or the purpose of the assignment? Or does it seem to come out of left field?
• Does the violence fit in with expected questions and issues? Or is it in some way gratuitous, purposeless or nihilistic?
  Is the violence in a piece of writing attributable to the thoughts and actions of one or more characters (or the narrator of the piece), or does the violence seem to come from the author?
• Does the violence seem to be intentional (i.e., the writer is intentionally trying to create violent characters), or does the disturbing nature of the material seem to be leaking out around the edges in a way that seems to have escaped the author’s control?
• Are there indications of impulse control in how the character approaches situations and interactions, or does the character demonstrate a lack of self-awareness and moral consciousness? Is the violence glorified or admired? Or does some moral redemption take precedence over the violence?
• Is the writing excessively violent? Do characters respond in violent ways that are above and beyond what would be expected from that particular character’s role?
• Is the violence the core of the written work or just one component of a larger piece?
• Is the violence general (for example, rampaging aliens are tearing to bits everyone in New York) or is the violence directed at a particular person (who is named in the writing) and/or at a particular group? Is the violence situated on campus or in the local community, or is the violence directed at a generic, mythic, or far-away locale?
• Is the student discussing thoughts of suicide? If so, does the student include specifics about how he or she might act on these thoughts?
• Is this the first time the student has turned in writing that you are concerned about?Are there other warning signs or indications (see below) that are cause for concern?

Associated Behaviors

• Suddenly deteriorating academic performance: A student who has been particularly conscientious about their academic work and is now missing classes, neglecting assignments, etc.
• A fixation on death and violence, such as a morbid fascination with and exposure to violent movies, games, music or other artwork.
• Dramatic changes in the way a student relates to others: Is an outgoing student suddenly more withdrawn and quiet in the classroom? Are they no longer friendly with students with whom they once seemed quite comfortable? Or is the student suddenly much more outgoing, talkative, or even intrusive or aggressive with classmates? Is the student dropping hints about disturbing, destructive or abusive relationships?
• Depression: Does a student seem much more negative, irritable or sad than usual? Are they crying in the classroom or needing to leave the room suddenly because of difficulty controlling emotions? Does a student express loss of hope or loss of future-oriented direction?
• Actual threats made to other members of the class, the professor, etc.

What to do

It is normal for faculty/staff to feel overwhelmed when dealing with disturbing situations, and there are many formal and informal ways to help students you are concerned about.

File a CARE Report online.

• Alerting the Dean of Students through a CARE report, email, or call initiates further review. It does not “get the student in trouble.” It is an effort to provide care and support to the student and also determine whether a threat to self or others exists. 

If you decide to talk with the student, approach the student informally, outside of class, and ask the tough questions in a compassionate, non-judgmental manner.

• Focusing on the content of a piece of writing rather than its writer is especially helpful. For example, “I was struck by this piece you wrote. I would like to hear more about what you were trying to do in this piece.” Or, “This piece feels very sad. Is that what you were trying to convey? For what response?” Generally, open-ended questions asked in a gentle but assertive manner can elicit richer responses.

Classroom Considerations to Support Student Mental Health

• Acknowledge that students have lives outside their academic pursuits (as well as other courses with additional responsibilities) and support them to find balance.
• Determine what flexibility you’re comfortable allowing from the outset and develop policies that are mindful of both student needs and your own.
• Communicate policies and expectations clearly to your students in the syllabus and throughout the semester.
• Design a flexible syllabus (e.g., allowing a certain number of absences without an impact on participation grades, granting extensions, dropping the lowest exam). Allowing for mistakes and flexibility can keep students stay motivated even if they fall behind or miss class due to health or personal issues.
• Provide multiple options for submission format so that students can demonstrate what they have learned (e.g., different types of test items, portfolios, presentations, single-topic discussions).
• Acknowledge and celebrate multiple forms of learning by including a variety of content to accommodate visual and auditory learners, allowing participation points geared toward both introverted and extroverted students, and assigning coursework that incorporates a variety of different learning styles.
• Allow students to drop 1 or 2 assignments/quizzes “no questions asked.” This saves time and energy negotiating over emails.
• Set deadlines for assignments at a time of day that encourages students to get enough sleep (i.e., avoid midnight or late night deadlines).
• Ask yourself: Do my policies balance structure with flexibility? When you have to turn down a student’s request, do you offer alternatives or leave them to figure out next steps on their own?Structure helps us and our students manage time and workload, while flexibility acknowledges the difficulties students may be facing. Example: “I understand that unexpected things can happen, so to provide some flexibility you can turn in two weekly assignments up to 48 hours late.”
• Consider making a student-professor meeting a course requirement.
• Acknowledge mental health openly throughout the semester to destigmatize it, e.g., “We are approaching midterms, which can be a stressful time. Please make sure you take care of yourself and know that we have an array of mental health services available on campus.”.”
• Check in during stressful times, such as midterms and finals, or during national, global, or campus events that may increase students’ stress.
• Send an email or survey to students before the first day of class to get to know them. Ask about their backgrounds, interests, strengths, needs, and other topics, and try to adjust the classroom and course content accordingly.
• Take a “Brain Break” during class sessions and encourage students to take a break from the class content, interact with classmates, stretch or engage in movement, or practice a breathing exercise. Having a consistent break time each class session helps students be aware there is a break coming and focus more intently during class.
• Give students advance notice about which assignments may be more challenging or take longer to complete in order to reduce last-minute stress and help students plan ahead.
• Consider granting an extension on an assignment to the entire class if one or more students have asked for one. If one student is overwhelmed and asks for an extension, it is likely that others feel the same way but might not feel comfortable asking for one.
• Use exams and other assignments as teaching tools, rather than the “end” of learning. For example, instead of handing out grades to students, go over the exam or assignment and discuss areas of common struggle so students can learn from them.
• Create opportunities for students to submit corrections on homework, quizzes, or exams. Ask students to make revisions based on feedback for assignments and projects.
• Consider incorporating for-credit assignments that encourage students to care for themselves
  (e.g., attending Wellness Wednesday workshop, joining a campus organization).

Training

Question. Persuade. Refer. (QPR) Training All faculty and staff are encouraged to attend a QPR training. Upon request, Counseling Center staff can attend departmental meetings to make the training more accessible. Information about training current offerings.

Mental Health First Aid Training These are offered regularly through the Student Wellness unit on campus. If you’re interested in learning more, please contact Halie Darby, Assistant Director of Student Wellness (darbyh@etsu.edu).

Be There Training This is an online, self-directed module designed to inform students about how to respond to their peers who may be struggling. While this was created for peer support, it covers a wide variety of important topics that can increase faculty/staff skills as well. 

Several offices on campus (Dean of Students, Counseling Center) have presentations available addressing how to effectively support students. If additional training is desired beyond the information provided in this guide or on the Counseling Center website for Faculty/Staff, please feel free to request a consultation or workshop.

• The Dean of Students has in-person/virtual training regarding disruptive students/ CARE case management

This guide was made for ETSU Faculty and Staff by Dr. Alison Bible using content from the wonderful resources and documents created by the following universities/organizations: The Ohio State University, University of California System, University of Michigan, Washington University, UNC Chapel Hill, Simon Fraser University, University of Montana, Active Minds, and the JED Foundation. Additional information on these resources can be provided upon request.

Care Report Process

1. Student Problem Identified: You identify a students is experiencing an issue/struggle through direct observation or student disclosure.
2. Referral to the Dean of Students Office: Submit a Care Report with your observations or the information provided to you.
3. Receipt and Assignment of Report: the Dean of Students/Assistant Dean of Students reviews the report and assigns the report to the appropriate staff member for next steps.
4. Outreach: The reporter will receive an email confirming receipt of report; Dean of Students staff will reach out to the Student of Concern within 24-48 hours.
5. Meeting and Follow-up: There may be meetings or additional outreach with the student, as needed. If the student does not respond to outreach, other interim steps may occur, or the report may be closed. The report will be kept in Care System, in case other concerns arise.