Students with a mental
illness
"The line between mental health and illness
is blurred; much is to be learned from one another across that line.
Our understanding of the human condition is enhanced in an educational
environment that values diversity of experience and expression and fosters,
through support policy and practice, the intellectual and personal growth
of all who work and study."
(Hoffman & Mastrianni, 1989)
Student profile
Meg
Bipolar Affective Disorder is a psychiatric
condition that is characterised by episodes of severe depression and
mood swings. It has a genetic, biochemical cause.
I experienced my first depression
episode during my first year at university, when I was in my late
teens. Then I was at a country university, where there was no psychiatric
help. In the past, I have had to use major tranquillisers to help
control this condition. They cause side-effects like a 'hangover'
feeling in the morning, tremors, muscle stiffness and weight gain,
which others often mistake for 'looking odd.' There is a perception
in the general community that if you have had a breakdown you are
a 'fruitcake,' so this sort of attitude can put you off telling anyone
about your disorder. I found when I was studying that there was lack
of awareness about serious psychiatric conditions amongst student
counsellors and academic staff. This meant it was harder to negotiate
extensions of time and leave of absence for long illnesses.
Go ahead and ignore any negative feedback
you might get. At university you may feel like a small fish in a big
pond and you'll have to shout to get noticed. Don't be afraid to tell
people about your disability. The more people who succeed and are
open about having experienced episodes of mental illness, the easier
it's going to be for all of us.
Meg, Graduate with a PhD in Behavioural
Sciences, now a university lecturer
Mental illness often develops between the
late teens and early twenties. Tertiary students, therefore, can be
a particularly susceptible group. The impact of mental illness can disrupt
educational plans causing students to withdraw from their course or
take a part time subject load.
Mental illness can affect the student's
ability to think and relate to other people and can be characterised
by feelings of despondency, anxiety and fear. These feelings may be
so overwhelming that coping with everyday activities becomes difficult.
The student may at times be unable to differentiate between reality
and fantasy and may have difficulties with organising their thoughts.
Definition
The Disability Discrimination Act (1992)
defines mental illness as "any condition which affects a person's thought
processes, understanding of reality, emotions or judgement or which
results in disturbed behaviour, for example, a person with a mental
illness, neurosis or personality disorder".
Mental illness can include:
- mood-related disorders (depression,
bi-polar)
- anxiety- related disorders (phobias,
panic, post-traumatic stress, obsessive compulsive behaviour patterns)
- psychoses (schizophrenia)
- personality disorders (borderline personality
disorder and anti-social personality disorder)
- eating disorders (bulimia, anorexia
nervosa)
Under the Mental Health Act NSW (1990),
psychiatric disability is referred to as:
A condition which seriously impairs, either
temporarily or permanently, the mental functioning of a person and is
characterised by the presence of one or more of the following symptoms:
- delusions
- hallucinations
- serious disturbance of mood
- sustained or repeated irrational behaviour
indicating the symptoms mentioned above.
Due to the episodic nature of many mental
illnesses, students may function very well for long periods and then
suddenly encounter difficulties.
Some students may have a long history of
mental illness, have experienced hospitalisation, be taking medication
and/or undergoing psychotherapy. These students will often require ongoing
assistance whilst studying such as examination accommodations, extensions
of assignment deadlines, copies of lecture notes to cover periods of
absence and a quiet area in which to rest.
Other students may experience their first
episode of mental illness whilst at university. Similar accommodations,
such as additional examination time, increased flexibility about assignment
deadlines or notetaking assistance in case of absence, will help at
this time but may not need to be an ongoing service.
Often medications prescribed for the above
conditions have side effects that negatively impact on study, eg difficulties
with concentration, blurred vision, impact on short term memory, and/or
induce physical symptoms like dry mouth, nausea, tremors and insomnia.
Myths about mental illness
- students with mental illness are dangerous
- students with mental illness are likely
to use more services than other disability groups
- students with mental illness are more
likely to be disruptive
- mental illness = intellectual disability
- providing services to students with
mental illness compromises academic integrity
Realities
- few students with mental illness are
dangerous to themselves or others
- students with mental illness do not
use more services than students from other disability groups
- most students with mental illness are
not disruptive in lecture or tutorial situations
- limitations are NOT intellectual, although
the illness can interfere with cognitive functions and the learning
process
- services assisting students with mental
illness provide them with the opportunity to continue studying on
an equitable basis
- mental illness manifests uniquely to
each person
- low self-esteem as well as fear of
a recurrence of illness are common
- self doubt or fluctuating levels of
confidence
- one in four people will undergo some
form of mental illness during their lives
Impact of mental illness on learning
Common difficulties associated with mental
illness can include:
- decreased concentration, confusion
and disordered thinking
- difficulties with self-perception and
perception of others
- mood highs and/or lows
- sensations of pain, torment or loss
of sense of reality
- fluctuations in motivation
- reacting to all of the above in ways
that others don't understand
- embarrassment, low self esteem and
experiences of isolation
- side effects of medication prescribed
to manage symptoms
There is an increasing range of services
now provided to students with mental illness at tertiary institutions.
These services assist students to manage their illness and continue
with their studies.
Disclosure and confidentiality
Within the tertiary education sector, unlike
the primary and secondary system, self-advocacy and disclosure are ultimately
the responsibility of the student with a disability, and the institution
cannot force a student to disclose.
Many students with mental illness are unwilling
to self identify, as they are apprehensive about being stigmatised and
discriminated against. Fear of breach of confidentiality also acts as
a deterrent to identifying.
The institution's role, therefore, is to
develop policies that promote an atmosphere of acceptance and trust,
and ensure that services are provided in a confidential manner.
University staff members should not expect
to obtain information about any student from a counselling unit. Confidentiality
between Counsellors and the users of these services requires a formal
permission to release information to a third party signed by the client.
Confidentiality can only be breached in the following circumstances:
- if direction is given by the client
to disclose information to a third party or parties. This direction
must in the form of a signed statement by the client.
- if it is a legal requirement eg a response
to a legal subpoena for documents to be produced or for the counsellor
to appear before a State or Federal Court. Other circumstances would
include an over-riding legal requirement to breach the understanding
of confidentiality. These circumstances would normally involve statutory
obligations, illegal or criminal activities or the prevention of harm
to others.
- if there is an issue of duty of care.
This occurs when the counsellor and/or their direct supervisor consider
the client's behaviour to be a danger to themselves or others.
Recognising a student with a mental
illness
Behaviours that may be indicative of various
mental health problems are:
- withdrawal from activities
- impaired concentration
- fluctuating attention
- irritable behaviour
- weight loss
- persistent sadness and tearfulness
- worry and agitation
- aggressive behaviour
- lack of interest in life
- inappropriate behaviour including disruptive
or anti-social
- delusions (false beliefs)
- grandiose behaviour
- extreme euphoria
The above behaviours may indicate a mental
illness. However, a diagnosis can only be arrived at through an intensive
interview process with a therapist or medical practitioner.
Disruptive or Aggressive Behaviour
When a student exhibits difficult behaviour,
academic staff may not initially consider that this behaviour could
be symptoms of a mental illness. These situations can be associated
with highly disruptive behaviour in lectures, sometimes including threats
of violence or perception of imminent danger. However, this type of
behaviour is uncommon.
Disruptive behaviour will prevent other
class members' ability to concentrate and participate in the lecture
or tutorial, and staff and students may often feel powerless to act.
However, any student behaving in a disruptive manner should be asked
to leave the lecture or tutorial and the lecturer should speak to them
privately at a later time.
At that time, the staff member could suggest
to the student that they go to the Counselling Unit and/or make a referral
to the Unit if the student agrees.
If the behaviour is aggressive and threatening,
or poses a danger to themselves or others, campus security may need
to be notified.
It should be noted that students without
a mental illness might also display aggressive or disruptive behaviour.
Students at Risk
A student who appears depressed, expresses
feelings of hopelessness and helplessness, whose behaviour seems to
have changed significantly or talks or hints at committing suicide should
be taken seriously. Staff should consult the university counselling
unit to find out effective ways of dealing with the situation (which
could include actively encouraging the student to see the counselling
unit).
Whilst the above behaviours can indicate
that a student may have a mental illness, many students with mental
health problems will show few outward signs.
Unfortunately, a student with severe mental
illness is more likely to express their difficulty through absence from
class and/or gradual withdrawal from university life. It is important
that the student be referred to Counsellors by academic or general staff
if an opportunity arises.
Teaching strategies with a mental illness
Academic staff have found the following
strategies useful when working with students with mental illness:
Large groups
- A student may have difficulties coping
in a large lecture situation, and may have difficulties attending.
In this case, tapes, copies of lecturer's notes or a notetaker can
assist.
- Tapes and notetaking may also be useful
if a student has a period of absence from their course.
- Changing the weighting on examinations
and class participation.
Small groups/tutorials
A student may have difficulties participating
in tutorials because of withdrawal or communication difficulties. Strategies
include:
- adjusting attendance requirements,
eg. tutorial attendance
- asking the student if they require
clarification of any points as the illness or medication can cause
difficulties with concentration
- allowing the student to substitute
tutorial presentations with written work
- if the student will have difficulty
in contributing and participating because of their disability this
could be managed through the student consulting with the Disability
Officer or Counsellor to obtain a recommendation to lecturers on how
best to assist the student
Distance learning
Where university courses are offered through
distance learning, it may be possible to offer the student this mode
of study on a temporary or permanent basis.
Laboratory and/or field work
Anti-depressant medications can cause drowsiness
or affect ability to concentrate. This create difficulties for the student
in handling chemicals, equipment or machinery or undertaking fieldwork,
therefore alternative assessment could be granted, where possible, or
the student be allowed to do the work at a more suitable time.
If you are aware that the student is taking
medication that may affect their ability to operate machinery speak
with the student privately and ensure that all relevant staff are informed.
Alternative assessment strategies for
students with a mental illness
Students who may have difficulties doing
written examinations could be offered alternatives, eg verbal examinations,
audiotape presentations or additional assignments could substitute for
examinations.
Students choosing to do examinations can
if required be offered additional time for writing or rest breaks and
a separate room in which to do the examination.
Assignments
Extension of deadlines for assignments
and essays can also help students with mental illness by alleviating
stress.
Examinations
- additional time for examinations
- separate room in which to sit the examination
- permission to have rest breaks during
the examination
- permission to sit examination outside
of the usual examination period
- permission to replace examinations
with other forms of assessment
Other Strategies
- suggest to the student a part time
subject load may be appropriate if they are falling behind or failing
- where possible, staff making time to
see students in need without a prior appointment
- extra tuition
- help with organising administrative
details, such as deferring, withdrawing without failure or adjusting
subject load
- flexibility with timetabling where
possible, as students taking medication often find attending morning
lectures very difficult
- a quiet safe area for the student to
go to when stressed
- staff training to increase understanding
and awareness of mental illness
- assistance with arranging peer support/peer
mentoring
Self-Help Strategies
Suggest to the student that they might
consider:
- seeking assistance from the Disability
Officer on campus
- learning stress management/relaxation
techniques
- seeking help with study skills, eg
from the Learning Centre on campus
- establishing a small student study
group
- establishing a supportive relationship
with a university counsellor
