Indicators of mental distress

Changes in mood and demeanour can provide the first signs that all is not well. Mood swings and social withdrawal may indicate some degree of emotional distress. Any of the following, might provide an indication that something is not right for a student and s/he could be experiencing some degree of mental health difficulty. It is important to view this list in terms of a collection of signs rather than as a diagnostic tool. 

• Low mood
• Erratic or unpredictable behaviour
• Agitation or overt anxiety
• Social withdrawal/avoidance of social interactions or contact
• Reduced academic attendance
• Sleep or appetite disturbance
• Poor concentration and or motivation
• Unexplained prolonged crying
• Tendency to abuse or self-medicate with alcohol or drugs
• Ideas of or actual self-harm
• Physical symptoms as a manifestation of psychological difficulties are not unusual 

N.B. none of these in isolation indicates an enduring mental illness but the presence any of one or more of these factors might suggest the need for concern.

Less commonly individuals may exhibit:

• Disordered thoughts
• Delusions
• Hallucinations
• Elation, excessive self-confidence and a loss of connection with reality 
• Behaviour inappropriate to the social context
• Thoughts of suicide or self-harm

What to do if you are concerned

If you are concerned about a student’s wellbeing:

•  Be aware of the available appropriate services. It’s useful for everyone to have information at hand on the support services available within the College. The College A to Z booklet will have the contact details of all support services within the College.  Further information can also be found on the Student Support Zone webpages.
• It is important to talk with the student and let them know that you are concerned and why you are concerned (e.g. you’ve noticed changes in their attendance/they look sad and you wonder if something is troubling them). Simply asking the student how s/he is may provide an opportunity for them to discuss their concerns with you. Be prepared to give them time so that you can listen attentively. If there are constraints on your time, inform them of this from the start of your conversation that this is the case, and consider arranging a more suitable time. It is important that you do follow this up if you have agreed to meet at another time
• Be open and honest with the student in your initial contact. Remember that the student might avoid seeking help because of concerns about the consequences of telling someone and the responses of others. Many students are terrified that disclosure of mental health issues will count against them in their department or with future employers.
• Listen carefully and respectfully to what the student is saying to you. Do not dismiss their worries even if they do not appear to be important to you.  You may not fully understand their particular situation and their concerns will be extremely important to them  
• Treat each student as an individual and ask what support they might need from you.  Just knowing someone has noticed, cares, is interested and is able to give their time can be incredibly supportive and helpful
• Re-assure the student that where possible you will keep what they say confidential. Let them know that to offer the best support you would like their permission to pass on information on a 'need to know' basis if appropriate.  It is also important for you to let them know that if they, or someone else, appears to be at risk, or if their behaviour is disruptive to others, you have a duty to consult others within the Colleges support services  
• Help the student to find the appropriate service if necessary.  Encourage the student to speak to someone who will be able to instigate support 
• If the student indicates that he/she is experiencing mental health difficulties, it is often useful to find out if they are already receiving support from the Student Counselling and Mental Health Advice Service, Disability Advisory Service, their GP or other external services  
• Staff should speak to their line manager if they are not clear how to help the student. This should be done without disclosing the identity of the student, if possible. It is also possible to consult with the Student Mental Health Adviser or speak with a Counsellor or Disability Advisor, without disclosing the student’s identity
• Don’t offer help beyond your role. It is not your responsibility to solve the student’s problem. Consider any potential conflict with your professional role and whether you know how to access support for yourself. Do not be reluctant to refer on. It is important to recognise personal and professional limitations when offering support 
• Provide information about the Student Counselling and Mental Health Advice Service, Disability Advisory Service, the Imperial College Health Centre and College Tutors/College Senior Tutor 
• Consider offering the student an invitation to come back and talk to you in the future

Passing on information and confidentiality 

The prime consideration is the safety and wellbeing of the individual concerned and those around them.

In cases where a student discloses that they are having difficulty in coping and are struggling due to issues connected with their mental wellbeing ask the student if s/he will consent to your passing on information. Explain the benefits of passing on limited information to others within the College and how this can help set support mechanisms in place. If the student is still not happy for you to pass on information explain that if you are unable to do this, it may limit the support you are able to provide. Where possible follow this verbal advice up with an email repeating what you have said, stating that even though they have not given permission to disclose information on this occasion, they may change their minds at any time. It would be useful to add in links to the student welfare web pages giving details of support available in the College. When you next meet with this student asked them how they are and whether they feel they can now allow you to pass on information and initiate support.

If you feel that the student or others around them are at risk or that the situation is likely to constitute a medical emergency, then you may need to override their wish for confidentiality and pass the case on to an appropriate support service.  

If student expresses thoughts of suicide this would constitute a possible emergency and you will need to seek advice from, Imperial College Health Centre or the Student Counselling and Mental Health Advice Service.

If in any doubt seek advice from either Imperial College Health Centre, Imperial College Student Counselling and Mental Health Advice Service or the Director of Student Services. You can do this without disclosing the student’s details.

Dealing with difficult and crisis situations  

In potentially difficult situations, it’s useful for you to be aware of the correct procedures, including who to inform and who can give you help. Always be prepared to seek help when you need it.

If you are concerned about approaching a student in a crisis it’s helpful to remember the CALMER acronym

C – Calm it is important for you to remain calm and this will help student to feel confident in your support.

A – Approach assertively outlining your concerns in a sensitive and straightforward manner, e.g. ‘I have noticed that you seem upset. I am concerned and would like to help if I can?’

L – Listen to the student if s/he is willing to talk, focus your attention on them and don’t make judgements

M – Motivate - recovery from even severe mental health difficulties is possible and support is available both within the College and from external services

E – Encourage the student to access appropriate self-help support. E.g. Student Counselling Service/Imperial College Health Centre

R – Remember you are not alone. If you are concerned about the student you may need to talk to someone about it also. Remember to maintain your professional boundaries.

It is important to:

• Ensure your safety and that of others, including the student involved 
• Assess whether you need immediate support.  If you are in need of urgent immediate support, contact Security.  
• Ensure the appropriate agencies are contacted 
• Engage with the student – if possible or appropriate 
• Be clear and direct, yet non-confrontational or threatening 
• Ensure that you have someone to talk to after the event – you may wish to speak to a professional. 
• All College staff and members of their family living with them can get free professional and confidential help from Confidential Care, the College's Employee Assistance Provider, 24 hours a day 7 days a week. Please call 0800 085 4764 or email assist@cic-eap.co.uk

Medical emergencies 

If you consider the student to be at risk of harming themselves imminently: 

1. Consult Emergency Contact Guideline
2. If the situation is violent or potentially violent, remain as calm as possible and contact Security (extension 4444 at South Kensington, Charing Cross, Chelsea and Westminster, Hammersmith, Royal Brompton and St Mary’s campuses, 42444 at Silwood Park and 3999 at Northwick Park) giving your name, the student’s name, contact telephone number and exact location 
3. It is important to try and distinguish between those students who are simply having violent thoughts and those who are likely to act; the former may be dealt with using the guidelines above 
4. If there is any uncertainty err on the side of caution and contact Security 
5. It is also appropriate to seek Security’s help if an ambulance is required (this is the case for any circumstance); Security can then help the ambulance get to the right place 

The best way to defuse a violent situation is to prevent its development. 

1. If you feel uncomfortable about an individual, do not meet them alone; consider meeting them with a colleague or in a public place. If you are alone let someone know where you are and take a mobile telephone 
2. If you do have to meet in a private space, try and position yourself nearer to the door 
3. Listen carefully, encourage the student to seek professional help, have the contact details of appropriate agencies with you 
4. If the temperature of the meeting rises, remain calm and talk to the student. 
5. If the situation continues to escalate, extricate yourself from the situation and/or call for immediate help 

Mental Health Difficulties Protocol

Mental Health Difficulties Protocol (PDF)

Responding to concerns raised by a third party 

You might be approached by peers or flatmates of a student with possible mental health difficulties. Within this context try to: 

1. Listen to their specific concerns 
2. Explore whether they will give consent for you to use the information they provide 
3. Respect the confidentiality of the student/individual with possible mental health difficulties if they are already known to you 

Advise how the third party might get support for themselves and more specific/expert advice on how to manage particular difficulties with such an individual, from the Student Counselling and Mental Health Advice Service, Imperial College Health Centre or Disability Advisory Service.