Tertiary Initiatives for People with a Disability
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Succeeding with a psychiatric disability in the university environment Information and advice for students and staff |
Some years ago a patient of mine, seeking to explain to a University Professor her difficulties in submitting her assignment on time, revealed that she had been diagnosed as having schizophrenia and was on medication. The Professor's response was that the solution to her schizophrenia was not to have any contact with her family, and that she should stop taking medication and seek to control the way she was thinking instead. I know that my patient's account of her interaction was correct as I rang the Professor (yes he was a Professor), subsequently, on her behalf.
Just because people are working and studying in a tertiary institution and can therefore be expected to be reasonably knowledgeable, does not mean that they are immune to fallacies about mental disorder. Indeed, universities may have a greater proportion of people who have erroneous ideas about the nature, cause and treatment of mental disorder, and who at the same time are highly judgemental or rejecting towards those who suffer. It is not so long ago that it was authoritatively taught at university that schizophrenia was a myth, or else the product of family interaction, or that it may actually benefit the person.
This booklet is a very useful guide for those suffering from mental disorder, to negotiate their way through university, with valuable hints on study which are clearly based on accumulated real experience. However, from my point of view, the most useful aspect of this booklet is the information and advice it provides to those not suffering from mental disorder, but with whom the sufferer may have to deal in attempting to complete a university course. It illustrates yet again, that part of the problem with mental illness does not reside in the sufferer, but in those around them, and if I could paraphrase Eldridge Cleaver, "we are part of the solution".
Dr F Varghese
Associate Professor of Psychiatry
The University of Queensland and
Chair of Mental Health
Princess Alexandra Health District, Brisbane
Jan's late teens and early twenties were turbulent. She suffered from delusions, was treated for a psychosis and admitted to a psychiatric hospital where she was diagnosed as suffering from schizophrenia. She was later able to re-establish her sense of equilibrium and attended university. Initially, she was advised by others that she should not attempt tertiary studies or that she could not succeed in them. However, Jan persisted. She gained an increasing understanding of her illness and developed strategies to address potential difficulties. In addition some accommodations were made by the university in terms of a reduced work load. Jan went on to graduate and is now working in her profession.
With some identifying details changed to protect confidentiality, this is a true and recent account of a student succeeding in her tertiary studies despite having a psychiatric disability.
This story leads us to ask:
I What can we do to encourage and support existing and potential students with psychiatric disabilities so that they can be equally successful?
I How can we influence the university to provide an environment which will enhance opportunities for success for students with psychiatric disabilities.
Students with a psychological or psychiatric impairment may present significant challenges to all members of the university community. Yet many people on campus are unaware of the issues involved and how they can be addressed to ensure the success of students with a psychiatric disability. We believe that this booklet is an innovative move toward helping all involved become better informed.
The booklet is an outcome of an Equity project "Identifying Needs and Development of Resources for Students with Psychiatric Disabilities", funded by the Queensland University of Technology.
Consultations and focus groups were held on three campuses of QUT over a six month period to identify the 'real' issues faced by staff and students, and to select strategies which would be most effective in addressing them. Consultation with associated key stakeholders was integral to developing this material. Interestingly, the central issue that emerged was a general lack of information about psychiatric disability.
We are indebted to Helen Glover and Melanie Scott, of Glover, Scott and Associates for carrying out a needs assessment and developing the resource material. We would like to acknowledge the input and support provided by the Tertiary Initiatives for People with Disabilities (TIPD) reference group who assisted in the development of the final materials: Prof John O'Gorman, Glenda Page and Di Paez. Thanks also to Geoff Foster, ReportWright, for copy editing, Glenda Page for proof-reading and the QUT Publications and Printing Unit for production. Finally, we wish to thank all the students and staff members who gave their time to be involved in this Project.
Robert Schweitzer
Head, Counselling Service
Elizabeth Tindle
Psychologist
Kathy Newley
Disability Officer
Sandie Evans
Disability Officer
Counselling Service
Queensland University of Technology
Private Bag No 2
Red Hill Q 4059
Australia
e-mail: r.schweitzer@qut.edu.au
Table of Contents
IntroductionFurther Reading and Resource List
Overview
This booklet has been developed with the help of many students and university staff, and is designed as an informative and practical guide for:
The three key objectives of the booklet are to:
As well, this booklet aims to provide some valuable insights into the nature of psychiatric disability, dispel some common myths, and explore methods of gaining and maintaining mental health.
What a mental illness is
Mental illness is a broad term used to describe a wide range of diagnosable psychiatric illnesses that impair a person's ability to think, feel and behave in a manner that allows optimum functioning in day to day life.
Many mental illnesses have their first onset in late adolescence or early adulthood, a time when many people are at university.
Some people may experience a one-off episode of mental illness, while others may experience ongoing symptoms. Most mental illnesses are episodic and these days the majority are treatable.
It is estimated that one in five (20 percent) of the population will experience a mental illness at some point in their lives.
People who have a mental illness can and do live quality lives.
What a mental illness is not
We all go through stages in our lives when we experience uncontrollable feelings of fear, stress, depression, anxiety or feel as though 'we're losing control'. These periods are extremely distressing, but they are not generally considered to be mental illness.
It is sometimes assumed that mental illness and intellectual disability are the same. This is simply not true. While some people may experience both an intellectual disability and a psychiatric disability (dual disability) there is no connection between these two types of disability.
What is a psychiatric disability?
The terms psychiatric disability and mental illness are sometimes used interchangeably. More precisely, mental illness refers to the actual disorder, while psychiatric disability refers to the impairment the individual experiences as a result of mental illness.
Not every person who has had a mental illness will experience a disability. Many people recover from an episode of illness and go on to enjoy long periods of complete health. Psychiatric disability is seldom permanent, and the level of disability experienced often fluctuates.
In this booklet we have chosen to use the term psychiatric disability, as our concern is with the impact of the illness on students' functioning in the university environment.
How to succeed at university with a psychiatric disability
FACT: Many people who have had a psychiatric disability have successfully completed university!
'Initially, many people tried to discourage me from going to university. They thought I wouldn't be able to cope with the pressure. And there were occasions (especially around exam times) when I thought I wouldn't be able to cope! But I persevered and got through then graduated with honours!'
University life can be a difficult and challenging experience for anybody. But for a person who has a psychiatric disability the difficulties can seem overwhelming at times. With some careful planning however, a disability does not have to be an insurmountable obstacle to successful studies.
Do you disclose?
A common dilemma facing many students with a psychiatric disability is deciding whether to disclose (tell others about) their condition. There are benefits to disclosing, but many people feel that by doing so they will become vulnerable, discriminated against or misunderstood because of people's misconceptions and assumptions.
'The first reaction from my friends was 'Oh my God!' But we soon got past that.'
Disclosure is a personal decision and you should consider your own situation and circumstances. Some issues to consider may be:
How will I benefit by disclosing?Who am I telling, and why?
Who else should I tell? Why?
Will I be better supported if I disclose?
Will fellow students be able to offer emotional and practical support (eg study groups, shared lecture notes)?
Are there support services on campus that I can use?
Will academic staff be able to accommodate my particular needs?
Will there be repercussions from disclosing?
Will I be stigmatised as "mentally ill" all the time?
Know yourself and your illness
Learn as much as you can about your condition and what triggers it. Understand the treatments and medications and the effects these have on you, and what impact they may have on life at the university.
There may also be techniques you can use to manage your condition, or even to prevent an episode. Work with a professional you trust to find what works for you.
'My psychiatrist and I really planned for my return to university. We worked out all the possible issues, and she is really supporting me.'
Identify your strengths
Identify what individual strengths you have and learn how to make these work for you in your university life. For example, you may function better at night than you do in the morning, so plan your study sessions for the evening. Or you may concentrate better in natural environments, so do your reading in a park! It may help to compile a list of your personal strengths and then determine how to use them best in your academic career.
'My medication leaves me drowsy in the mornings. I was able to change my early morning lectures this semester. It makes a difference!'
Identify areas where you may need assistance
It may be something as simple as needing extra time with a tutor or needing assistance with a study plan. Asking for help should never be considered a weakness. Recognising where and when you need assistance is a definite strength.
There are services and people on campus (ie Disability Support Officers, Counsellors, Health Services, Student Support Services etc) who are there to assist you. Teaching staff and fellow students are often willing to help you too, if they are asked.
'Just speaking with the counsellor was good. It was an eye-opener to learn the options available to me.'
Plan ahead
As the nature of most psychiatric disabilities is episodic, it is essential to be well organised and not to leave everything to the last minute. Cramming may be an effective tactic for some, but it can be extremely stressful. If stress is a trigger for your condition it would be wise to avoid last minute studying and assignment writing.
Have a plan for what you will do if something does go wrong. Too often it is a natural instinct for students to pull out of study when a crisis occurs, but there are alternatives.
A contingency plan is like an insurance policy, and may safeguard against additional stress if you do become ill. Again, find out about the sources of support that are available at your university and use them!
'In the end of semester rush I was really disorganised and found myself completely stressed out. I was a real mess and thought I'd fail everything. It was a good lesson though I'll never do that again!'
Know what resources are available
There are services on campus especially tailored to assist people with difficulties and disabilities. Find out about these early and learn what they have to offer. Do not wait for a crisis situation before seeking assistance. Be proactive!
Nearly all the support services provide assistance that is confidential and will not be recorded on your academic record.
'I am able to sit exams in a special room with less people, which may not seem much, but it makes a big difference to my anxiety levels, and to my concentration.'
Keep people informed
If there are changes happening in your life or in your condition, let your university supports know. For example, a change in medication, or a change in living arrangements, may have an impact on your illness. While they may not have an immediate effect on your study, it can be a good idea to let people know what your needs may be and how staff might best be able to help you. Waiting for a crisis situation may limit the options available to you.
'My biggest fear was what if I have to go to hospital? In my third year at uni I did. I was there for over two months. People I studied with would bring the lecture notes to me, and I managed to keep up with my assignments.''As soon as I got assignments I would start on them. I'd try and stagger the work as much as possible.'
Suggestions for university staff
'I was slipping so far behind and this was causing unbelievable anxiety on top of all the other symptoms! I eventually worked up the nerve to tell my lecturer, and he was awful. He told me it was psychosomatic. I think he thought I was just making an excuse to try and get an extension.He certainly wasn't interested in talking to me about it.'
'I eventually told my tutor when I was having difficulties on a new drug and was hearing voices for the first time in years. She was great it turned out her sister had schizophrenia. She was so relaxed about it.'
Students with psychiatric disabilities
Unlike those with some other disability, a student who has a psychiatric disability may be difficult to identify. The symptoms and difficulties that are experienced are not always visible. This does not mean that they are any less disabling.
Quite often, students are unwilling to disclose their condition for fear of being misunderstood, stigmatised or discriminated against. It is a common belief that disclosure will have negative repercussions; many may have already had unpleasant experiences with stigma and misconceptions. There may also be a fear of being viewed as an illness rather than a complete person. For example, people who have experienced schizophrenia are often seen as "schizophrenics". Not only does this sort of labelling make the illness the main identifying aspect of the person, it also has huge implications for the student's self esteem.
Since the first onset of many psychiatric disabilities occurs in late adolescence or early adulthood, there is a strong possibility that some of your current students will be experiencing a psychiatric disability.
While every mental illness has its own symptomatology there are some signs that might assist you to recognise that "something is wrong". These may include:
Students being treated for a psychiatric disorder may be on quite large doses of psychotropic medication. All drugs have side effects, but psychotropic medications have a reputation for impairing concentration, causing drowsiness, blurred vision, stiffness, shakiness, and a dry mouth. Quite often the observable signs of a psychiatric disability are a result of the treatment, not of the condition itself.
Interacting with students
It may be appropriate for you to speak with the student confidentially about your observations. You may be the first person to realise that something is not quite right.
Do not discuss your observations in front of the lecture or tutorial group.There is a danger that this may add to a sense of stigmatisation, paranoia or poor self esteem the student may already be experiencing.
Express your concern in private to the student. However, leave diagnosis and treatment to the appropriate professionals.
Ensure the student is aware of the appropriate supports on campus. In the first instance this may be the Disability Officer or Counselling Services. Familiarise yourself with these supports and what they offer. (Please refer to pages 14 to 20 of this booklet)
If the student's behaviour in class is not acceptable, then speak to them in private about this. It is your responsibility to ensure that other students are not disadvantaged due to inappropriate behaviour.
Practical help with study
There are some practical steps you can take to help a student who has a psychiatric disability to succeed in study:
- Understand the facts of psychiatric disability. Do not assume that a student is unmotivated or lazy.
- Quite often symptoms of their condition or the effects of medication may affect a student's ability to submit work on time or to sit exams in the traditional manner.
- Ask what support the student may need. Quite often the student will know exactly what specific assistance will make a difference.
- If the student does have periods of poor concentration, suggest audio-taping of lectures in addition to note-taking. This will allow students to revise lecture material at their own pace.
- Assessment time is obviously stressful for everybody and, for many people with a psychiatric disability, stress can trigger an episode. Speak with the student prior to deadlines about appropriate mechanisms that will not disadvantage either the student with the disability, or their fellow students. Try and accommodate the student's special needs as much as possible.
- Quite often the type and level of support needed by students will fluctuate. As most illnesses are episodic, many students may have extended periods where they do not need or want any special consideration. Be guided by each student's ability to cope with academic requirements, not by the diagnosis.
- Try to ensure that students are fully aware of the range of supports that are available to them. The Counselling Service and the Disability Officer have a wide range of practical ideas and strategies that may assist students in reaching their full academic potential.
- Perhaps students will need to be admitted to hospital or to take time off for other reasons. This does not necessarily mean they need to defer or cancel their studies. Many people with appropriate support (eg having someone deliver lecture notes) have studied from hospital. If appropriate, discuss this possibility with students when they are well. Again, the Disability Officer and/or Counselling Services may be able to assist in determining a contingency plan.
- Be aware of your own abilities and limitations. If you are in a situation that you are having difficulty with, or are unsure of how to assist a student, seek assistance. The Disability Officer or Counselling Services may be able to give you some advice.
Assistance in other areas
Academic requirements are not the only aspect of tertiary life that students with psychiatric illnesses may find challenging. Some have difficulty with the ever-increasing volume of administrative tasks. Students should be alerted to these requirements and the consequences of not addressing them.
It is often not due to laziness that certain forms or procedures may be neglected, but more due to confusion, embarrassment or disorientation. Some insight, understanding and guidance can make the world of difference. Again the Disability Officer or Counselling Services may be able to provide some practical assistance.
Integration into the social aspects of tertiary life may also be problematic for some students who experience a psychiatric disability. Making and maintaining friendship networks can be difficult. Encouragement should be given to students to make links with their peers. Some universities have even developed peer support groups and buddy systems which have alleviated some of the stress in negotiating the social and academic life at tertiary institutions.
With some factual knowledge, understanding and support there is no reason why people with a psychiatric disability cannot succeed in tertiary education.
Duty of care
The dual duty of care is often raised as an issue within academic environments. This is the dual responsibility of academic institutions both to ensure professional standards of its graduates, and to support its students in attaining these standards. Occasionally, a conflict between these responsibilities may occur. In his report on a recent Tertiary Initiatives for People with Disabilities (TIPD) forum, "Psychiatric Disability and University Study: Who Copes?" (1996) John O'Gorman writes:
'Universities, as providers of professional education, have a responsibility to the community and the professions to ensure fitness of the student to practice, but as educational institutions they have a primary responsibility to the students who enrol with them to maximise their development.'
There is no immediate solution to this issue, and much discourse between all stakeholders needs to occur. Each situation must be considered on its individual merits.
'Even though I have a medical certificate, I have been refused an extension. I find I have to continually prove my illness ... there's often an ignorant attitude from staff ... because it's an invisible disability, it's easy to ignore.'
A suggestion for staff faced with a situation where conflicts of responsibility occur is to discuss the issue with peers and course coordinators. This should be done in a manner that maintains the confidentiality of the student, and respects the interests of all parties.
Supporting a student with a psychiatric disability
'I'd been mildly psychotic for about a week and then completely lost it in a lecture hall! There were two hundred people in the room! After I got out of hospital I thought I'd never go back. But then this guy I used to hang out with rang to find out where I was.'
Sometimes we can find ourselves in a position where we are assisting a friend or fellow student who is experiencing symptoms resulting from a psychiatric illness. For some people this can be a daunting situation, and many are not sure of what they can or should do. There is no correct formula, or "recipe" to follow, and each situation and person is different but there are some general guidelines that may assist.
DON'T:
DO:
'It made a huge difference knowing there were people I could talk to. We formed a study group that met regularly. This really helped. I just know there were times I would never have got around to studying if they weren't there.'
Support available within the University
Universities often provide a wide range of services for students to utilise during the course of their study. For students who are seeking support and/or assistance with issues relating to their mental health, there is a number of useful contacts on most campuses. These may include:
The disability officer
The disability officer is a useful first contact for students who experience a disability of any nature. The disability officer will be aware of all the services available throughout the university, and will be able to assist you in:
Students who are not experiencing any current incapacity as a result of their illness may still find it useful to meet with the disability officer as a precautionary measure in case of future episodes. This will alleviate any frustration caused by illness at a later date (ie just before exams!) when available options may be limited.
Options for support may include:
It should be noted that this service is strictly confidential and will not be recorded on any academic record. Any details regarding your illness/disability will not be given to any person or body (eg course coordinators in regard to special consideration) without your full authorisation.
Health Services
Health Services provide a general health service at which it is possible to see a general practitioner for all health issues. It is possible to make an appointment to gain a referral to a specialist service. University health services generally bulk bill Medicare, so it is advisable to take along your Medicare Card to appointments.
Counselling Services
Counselling Services employ registered psychologists and social workers and offer assistance to staff and students across a broad range of areas, for example:
An appointment is generally needed and this can be made either in person or by telephone. Counselling Services provide a confidential service, and your details will not be recorded on any academic records.
Academic staff
It may be useful to contact academic staff in relation to your condition where appropriate. Lecturers and course coordinators may be able to assist with lectures missed due to illness, incorporating specific supports as needed, special consideration, and extensions on assignments if you are unwell.
Most universities have policies on confidentiality that staff are expected to adhere to, which should ensure that your personal details remain private. There are also policies pertaining to equity and discrimination that aim to ensure there are no negative repercussions to disclosing your condition.
Welfare department
Welfare departments are run by the student guild or equivalent body of most universities, and offer assistance to all students with issues such as:
Support available in the general community
General practitioners
General practitioners may be able to assist with most disorders and will be able to provide a referral to specialists as needed.
Specialists
Psychiatrists are able to assist with drug therapies, and treatment for psychiatric conditions.
Psychologists do not prescribe medications, but employ a wide range of therapeutic procedures. Treatments may include general counselling, cognitive behaviour therapies, or psychotherapy.
Some social workers and occupational therapists also specialise in the management of psychiatric conditions.
Hospitals
Many hospitals have psychiatric units that offer specialised in-patient care to people who have acute symptoms.
Public Psychiatric Units:
Princess Alexandra Hospital (07) 3240 2111
Prince Charles Hospital (Winston Noble Unit) (07) 3350 8111
Royal Brisbane Hospital (07) 3253 8111
Mental Health Centre
3A Mental Health Triage
Logan Hospital (07) 3299 8899
Private Psychiatric Hospitals/Clinics:
New Farm Clinic (07) 3358 3888
Toowong Private Hospital (07) 3371 5899
Wesley Hospital (07) 3232 7000
Belmont Private Hospital (07) 3398 0111
Community Mental Health Centres
Community Mental Health Centres (CMHC) provide a public health service that offers a wide range of individually tailored ongoing supports. Most incorporate multi-disciplinary teams (consisting of a range of professionals including psychiatrists, psychologists, social workers, occupational therapists and psychiatric nurses) to ensure appropriate support and treatment.
Community Mental Health Centres can assist with managing symptoms, treatment plans, medications, rehabilitation programs and basic living skills. Many offer a comprehensive service that may include home visits, after hours teams and crisis telephone lines.
Aspley 76 Zillmere Road (07) 3263 8888 Coorparoo 236 Old Cleveland Road (07) 3847 0900 West End Melbourne Street (07) 3846 9400 Fortitude Valley 162 Alfred Street (07) 3854 1605 Ipswich/ West Moreton Nicholas Street (07) 3816 1859 Caboolture 6/69 King Street (07) 549 58799
Community organisations
There are many independent community organisations that offer a variety of general services. Some organisations that may be useful to tertiary students are:
Queensland Association for Mental Health 20 Balfour St NEW FARM (07) 3358 4988
Offers:
Schizophrenia Fellowship of South East Qld 97 Arthur St FORTITUDE VALLEY (07) 3358 4424
Offers:
Association for Relatives and Friends of the Mentally Ill (ARAFMI) 884 Brunswick St NEW FARM (07) 3254 1881
Offers:
Brisbane group (07) 3394 4344
Offers:
Life line Emergency help line (07) 131114 Salvation Army Salvo Care Line (07) 3221 1233 Eating Disorders Association Inc 131 Leichhardt St SPRING HILL (07) 3831 6900
Offers:
Breaking Barriers New Farm Neighbourhood Centre 967 Brunswick Street NEW FARM (07) 3358 6000
Offers:
Relaxation Centre Brookes St, Fortitude Valley (07) 3854 1986
Information about specific mental illness
General information
There are different categories of mental health disorders that can now be identified, diagnosed and treated. A diagnosis is the category or label used to identify a set of symptoms. The specific personal experiences of an illness varies from individual to individual.
Categorisation
Mental illnesses fall into two distinct diagnostic categories: psychotic, and non-psychotic.
Psychotic illness
In the acute phases of psychosis people lose touch with reality. Thoughts, feelings and perceptions are seriously affected and people may see, hear, taste or feel things which are not shared by those around them (hallucinations).
People experiencing psychosis may also develop delusions (false beliefs). These beliefs may include feelings of persecution, guilt, extreme paranoia or grandeur.
Psychosis is commonly an extremely upsetting experience for those affected and can be quite incomprehensible to onlookers. Most people while psychotic do not have any insight into the inappropriateness of their behaviour and often feel considerable distress or shame once the episode has passed. Most episodes of psychosis are short lived and are effectively treated with medication.
Non-psychotic illnesses
Once known as neurotic disorders, non-psychotic illness includes conditions that affect feelings and emotions. Often these conditions can be so overwhelming that functioning in day to day activities is severely impaired.
Many symptoms of non-psychotic illnesses are not evident to others. They may include exaggerated feelings of stress, anxiety, sadness or fear. Obsessive compulsive disorders, phobias, and some forms of depression are all non-psychotic illnesses. Most conditions can be relieved by appropriate treatment which often includes medication and professional therapy.
Thanks to much research into the nature of psychiatric disability, effective treatments, and recent developments in psychotropic medication, many people who may in the past have been severely impaired by the symptoms of their illness can now lead functional, high quality lives.
Schizophrenia
There has long been a misconception that schizophrenia is having a "split personality" hence the metaphor Dr Jekyll and Mr Hyde. This is not true, a "split personality" is symptomatic of dissociative identity disorder.
Schizophrenia is a broad term that incorporates a range of psychotic illnesses that share common symptoms. These may include:
There is much debate about the cause of schizophrenia. Theoretical causes include: genetic factors, biochemical disposition, environmental causes and in some cases, substance abuse. Identifying why schizophrenia occurs is the focus of much current research.
The onset of schizophrenia usually occurs between adolescence and the mid-twenties. Schizophrenia is estimated to affect one percent of the general population and both genders are equally affected. It is episodic in nature, and some people experience only one or two episodes. Modern treatments for schizophrenia are quite successful and most people are able to live normal lives.
Functional implications for university study:
Schizophrenia may pose challenges to effective studying. Concentration can become severely disrupted. Due to the nature of particular hallucinations, some students find it difficult at times to focus on the 'here and now', and the demands of the course.
Bi-polar Disorder
Bi-polar Disorder (Manic Depression) is a disorder where moods fluctuate from mania (highs) to acute depression, often with no plausible reason. While many people experience long periods of stability, others may fluctuate between moods at a rapid rate. People with Bi-polar Disorder may experience psychotic symptoms in both the elevated and the depressed phase of the illness. This condition affects an estimated one percent of the population.
Symptoms during the elevated phase may include:
Symptoms during the depressive phase may include:
Functional implications for university study:
In the elevated phase of the illness concentration may be difficult or impossible. People may become disruptive, and grandiose goals may be set. In the depressive phase motivationlevels will be adversely affected and study commitments may not be met. Concentration may be impaired and feelings of hopelessness and despair will affect attitudes to study.
Eating disorders
Eating disorders is a term that identifies any dysfunction in eating habits. Bulimia Nervosa and Anorexia Nervosa are the most common eating disorders.
Causes may include: peer pressure, social factors and unresolved issues from the past.
Eating disorders affect people in every age group. However, most occur during adolescence or in early adulthood. While both genders experience eating disorders, the majority of sufferers are female.
Bulimia Nervosa
Bulimia Nervosa is a serious eating disorder that can lead to death if not treated. Large quantities of food are ingested in an uncontrolled manner, usually followed by compulsive purging either self induced vomiting, using laxatives or over exercising.
Controlling weight becomes the prime focus. Most sufferers are either normal or over weight. Treatment may include professional counselling, and in severe cases cognitive behaviour therapy, or psychotherapy.
Functional implications for university study:
A student suffering from Bulimia Nervosa will often be so occupied with bingeing and purging that attending lectures and studying will seem secondary. Memory and concentration may be impaired by poor nutritional status, and classes may also be missed due to hospitalisation.
Anorexia Nervosa
Anorexia Nervosa is a term given to people who 'starve' themselves to attain an unrealistic weight. Anorexia is often characterised by a refusal to eat in spite of intense hunger, weight loss of at least 15 per cent from ideal body weight, distorted perceptions of body image and an intense fear of weight gain.
Anorexia is a serious condition that may result in related medical disorders, and death. Treatment can include professional counselling, cognitive behavioural therapy, and in extreme cases hospitalisation, where feeding and nutritional education can occur under medical supervision.
Functional implications for university study:
Similar to Bulimia, students may experience problems with memory and concentration. In severe cases permanent brain injury can occur, and hospitalisation will prevent class attendance.
Depressive disorders
Depressive disorders range from the mild to the extremely serious, sometimes requiring hospitalisation. Everybody at times has experienced feelings of extreme sadness or grief, but for some people the symptoms are more intense, unprovoked, or last much longer than would normally be expected. Often people experiencing depressive disorders feel they should be able to "snap out of it" and are hesitant to seek help.There are two predominant types of depression:
Causes of depressive disorders may be attributed to genetic disposition, biochemical factors, life stress, or personality type. Someone with depression may experience:
Psychosis may also be experienced. Effective treatments include professional counselling, drug therapy, and in extreme cases electro-convulsive therapy (ECT).
Functional implications for university study:
Severe depression will adversely affect motivation levels and commitments may not be met. Concentration may be impaired and feelings of hopelessness and despair may affect attitudes to study.
Anxiety disorders
In certain situations anxiety is a normal emotion. However approximately five per cent of people experience extreme anxiety that severely impairs their ability to function in day to day life. Disorders include social phobia, post traumatic stress disorder, agoraphobia and panic disorder. Simple phobia is a term given to acute anxiety related to particular objects or situations.
Most anxiety disorders occur in early adulthood and are often (but not always) triggered by significant life events.
Symptoms may include:
Most anxiety disorders respond well to treatment and options include: professional counselling, systematic desensitisation, anti-anxiety medications. For mild anxiety good social support networks, relaxation therapies and ensuring a healthy diet, exercise and sleep often prove beneficial.
Functional implications for university study:
Concentration may be difficult. The nature of many anxiety disorders is all encompassing. Often the stress of exams and assignments may trigger episodes, so it is essential that the student plans a balanced workload.
Obsessional Compulsive Disorder
Obsessive Compulsive Disorder (OCD) is a severe anxiety disorder that has two components:
obsessional thoughts leading to compulsions to repeat certain behaviour.
Many people with OCD are initially able to disguise their behaviour, but symptoms often become pronounced as the disorder develops. There are many individual manifestations of this disorder but sufferers may experience:
obsessive thoughts about cleanliness, contamination, violence or any single issuerepetitive behaviour (eg can not stop washing hands)
compulsions, (eg continuous cleaning) or repetitive checking (eg the iron is off, the door is locked etc)
depression
anxiety.
Effective treatments include: professional counselling, cognitive behaviour therapy, psychotherapy and medication. Severe cases may be admitted to hospital for intensive treatment.
Functional implications for university study:
Compulsions may hinder punctuality for classes. The person may be distracted by obsessive thoughts that may affect study.
Personality disorders
People who have a personality disorder experience character problems. These symptoms are slow to develop rather than sudden. The cause can usually be attributed to an arrest of personal and/or emotional development.
Borderline personality disorder, anti-social personality disorder, histrionic personality disorder and narcissistic personality disorder are examples of personality disorders. Some disorders have symptoms of self harming, disassociation and blocking out. Most personality disorders are complex and extremely distressing. With many disorders, sufferers may become defensive, manipulative or difficult which in turn may have negative implications for families and friends.
Treatment may be difficult but intensive support, psychotherapy and medication can all be effective.
Functional implications for university study:
Students diagnosed with a severe personality disorder may experience disruptions to study due to the distressing nature of the disorder, inability to concentrate, and in some cases hospitalisation.
Mental health
Mental Health is much more than just the absence of a specific psychiatric disability. Most people are aware of the importance of maintaining their physical well being and employ strategies such as regular exercise, a balanced diet and regular check-ups as an integral part of life. Yet few people understand the importance of maintaining their mental health.
Everyone experiences stress in their lives, and while a certain amount is useful for motivation, levels should be carefully monitored. Stress can cause physical problems (such as high blood pressure, headaches, neck pain, fatigue) and may trigger psychiatric disability in some people. Students can be particularly prone to stress, especially around examination times. Many university staff also experience periods of extreme stress.
There are measures everybody can take to ensure optimum mental health. For instance:
Social responsibility
Universities are committed to increasing opportunities for people with disabilities to participate in all aspects of university life including education and employment. This commitment is based on a philosophy of inclusion, which promotes strategies to develop an environment which is sufficiently flexible to accommodate the diverse nature of all users. Inherent in this statement is the expectation that all staff within the university will be responsive to the needs of people with disabilities.
Legal obligations
There are two pieces of legislation which encompass the education and employment of people with disabilities: the Commonwealth Disability Discrimination Act (1992) and the Queensland Anti-Discrimination Act (1991). Universities also have equal opportunity policies which commit them to equal opportunity and freedom from all forms of discrimination in education and employment.
To comply with the disability legislation universities must make reasonable accommodations to ensure that people with disabilities are able to participate in work and study and have the same opportunities for success as people who do not have a disability, unless to do so would cause unjustifiable hardship, or adversely affect the individual or other people.
The Commonwealth Disability Discrimination Act (1991) defines relevant terms as:
Reasonable accommodations making adjustments or alterations (eg administrative, physical, procedural) where required to ensure equal opportunity for people with a disability. Each case needs to be considered in its own circumstances and on its own merits.
Unjustifiable hardship in some cases it may be unreasonable for a university to make required adjustments. Relevant circumstances in determining unjustifiable hardship include:
The key factor in deciding whether an adjustment is necessary or possible, is to have a thorough understanding of the effect of the disability on the individual and of the impact of the adjustment or alteration on the particular situation. The Human Rights and Equal Opportunity Commission is not required to consider a claim of unjustifiable hardship unless there is detailed evidence produced to support the claim. Staff from the University Disability Program will be pleased to assist and give confidential advice on disability matters that are of concern to the university.
The university is directly responsible for ensuring the requirements of the Acts are fulfilled, and can also be held vicariously liable for discrimination or harassment against a person with a disability by a member of staff or one of its agents.
Further reading and resource list
Many informative and helpful books have been written about mental illness and psychiatric disability. Most libraries have a broad selection of both factual and self help books. Community Organisations also often have libraries. It can often be beneficial to join such organisations to access their resources. Membership is inexpensive, and most organisations have reduced rates for students and pensioners. Some books that may be helpful are:
Backlar, P. (1994) The Family Face of Schizophrenia. New York: GP Putnam's Sons.
Burns, D. (1980) Feeling Good. New York: Morrow.
Camela, P. and Strahan, F. (1996) Voices of the River: Life Experiences of People with Mental Illness in Employment, Education and Training. Melbourne: Disability Employment Action Centre (DEAC) Inc.
Cozens, J. (1988) Nervous Breakdown: What is it? What Causes it? Who Can Help? London: Piatkus.
Heckler, R. (1994) Waking Up Alive. New York: GP Putnam's Sons.
North, C. (1987) Welcome Silence. Great Britain: Simon & Schuster.
O'Gorman, J. Ed. (1996) Psychiatric Disability and University Study: Who Copes? Tertiary Initiatives for People with Disabilities, Queensland University of Technology.
Queensland Association for Mental Health: National Mental Health Strategy (1996) pamphlets:
Mental Illness The Facts
What is Stigma?
What is Anxiety?
What is Bipolar Disorder?
What is Depression?
Robinson, F. (1996) Mary Jane (What is the Matter With) Living through Anorexia and Bulimia. Sydney: Random House.
Smith, M. (1989) I Always Wanted to be a Tap Dancer. Sydney: Women's Advisory Centre.
Wrigley, J. (1990) The Less Travelled Way? Melbourne: Collins Dove.
Videos
One in Five. Living with a Mental Illness. National mental health strategy. Commonwealth Department of Human Services and Health, Sydney, NSW.
Creative Teaching Inclusive Learning (1997). Tertiary Initiatives for People with Disabilities. QUT, Brisbane.
Funding
We are grateful to the following organisations for providing funding to undertake this project:
The Equity Section, Queensland University of Technology
Australian and New Zealand Association of Student Services Counsellors' Special Interest Group
Tertiary Initiatives for People with Disabilities.
For further information about TIPD, please contact webmaster
This page last updated: 1 Sept, 1999
