Distressed Student Protocol

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Responding to the Distressed Student

In distress but not an emergency: How to Refer to Counseling

Individuals in distress are often more ready to receive intervention during a crisis. The responder may be able to take this as an opportunity to reach out to the person to help by connecting the individual to available resources such as: the TMCC Counseling Center, veterans' resources, low-cost clinics, faith-based supports and other community partners including those serving specific populations (e.g., LGBTQI).

The responder may be able to assess the risk and determine the level of intervention and/or resources needed by following these steps:

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Signs of Distress

Students experiencing psychological or emotional distress may exhibit behaviors that would be out of the ordinary for the student and/or considered socially inappropriate or strange. Use of drugs or alcohol may also mirror these symptoms and the distressed student will still benefit from intervention.

Behaviors may include:

• Repeated or excessive disruptions (hostile or antagonistic behaviors)
• Inappropriate or exaggerated emotional responses to a given situation, including lack of emotional response to a stressful situations
• Loss of contact with reality, including rambling or incoherent speech, laughter that is out of context, visual, tactile or auditory hallucinations
• Significant decline in academic performance
• Change in interaction patterns in the class
• Frequent attempts to obtaining postponement of tests or extensions on assignments that are due

In addition, individuals who are in distress are at greater risk of suicide, especially when behaviors are new or have increased, often in response to a recent painful event, including loss or changes.

See the TMCC Counseling Center's Suicide Prevention Help page for more signs of suicide.

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Confidentiality

A student in distress has a right to privacy. In most situations, information provided by the student is confidential and is only released with student permission.

Written records, including student conduct reports, are protected by the Family Education Rights and Privacy Act (FERPA). Except in extraordinary circumstances, permission to release this information is to be given by the student in writing via an Authorization to Release Information form.

FERPA, and the code of ethics adhered to by the TMCC Counseling Center, does permit the release of information when necessary to protect the health or safety of the student or others.

When a student presents an imminent danger to self or others, it is both permissible and crucial to call 911 and notify the student’s emergency contact.

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Resources

Counseling

The TMCC Counseling Center coordinates prevention, intervention and post-intervention services for students. The Counseling Center, located in RDMT 115 and available during regular business hours, also provides consultation to faculty, staff and concerned others regarding how to assist a student who is displaying behavior that is raising concerns.

Faculty and staff in need of counseling services for themselves are referred through Human Resources to the Employee Assistance Program (EAP).

Distressed students, and those concerned about a student, are encouraged to come to, or call the Counseling Center. In crisis situations, the Counseling Center receptionist will follow Counseling Center protocol to locate either an available counselor or the counselor on call. Please be certain to notify the receptionist that you have an emergency or crisis situation.

Consultations with counselors can happen in person, over the phone or via email. During consultation, a professional counselor will provide education and support to help the concerned others know what to do/say to their student in distress, and help them identify resources. At the counselors' discretion, the counselor may contact the student of concern to offer services and, ideally, schedule an appointment for an intake and evaluation regarding suicidal ideation. In keeping with best practices, counselors log notes and contacts in a secure database and may bring cases to colleagues for professional consultation.

Strategies for a Referral to Counseling

• Walk Student to the Counseling Center
  When possible, a phone call to Counseling (775-673-7060) should precede this action in order to notify the office and allow them to prepare to see and evaluate the student. If your concern is after hours, the Crisis Support Services at 988 will walk you through helping the student or talk to the student directly.
• Call the Counseling Center and Consult Regarding What Action to Take (either immediate or in the future)
  When immediate action is anticipated, phone contact is best made openly, in the student’s presence and with his/her consent. Call with any concerns. Your intuition is most likely correct, and there is probably a problem.

Students cannot be mandated to receive a counseling intervention based only on the perception that the student is in distress or has a mental illness.

The goals in working with a distressed student are to facilitate evaluation, to stabilize the emotional distress, and to provide support and tools to keep the student safe and out of the hospital.

Training

TMCC's Counseling Center provides training to recognize and intervene with a person at risk of suicide. Trainings include awareness workshops such as Mental Health First Aid. All trainings are provided to members of the campus community at minimal, or in most cases, no cost.

See TMCC's Counseling Center Suicide Prevention training and dates.

Student Conduct Office

If a distressed student refuses contact with the Counseling Center and is behaving in a manner disruptive to the campus learning environment, a Student Conduct Complaint may be filed.

For more information, see the Vice President of Academic Affairs Student Conduct Policy.

The Student Conduct Officer will evaluate the situation and determine the best course of action.

The Student Conduct Complaint and Incident Report form is also available to anyone who is concerned for another person and is not comfortable with a direct intervention. If the behavior does not meet criteria for an emergency response, individuals may utilize the Student Conduct Complaint and Incident Report form to file an incident report electronically.

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When Uncertain Whether it is an Emergency

• See Also: Suicide Prevention Information

Stay calm and assess the situation objectively and rationally. The person in crisis will be feeling anxious and uncertain and may lose perspective of the situation.

If you are reflecting on a situation that happened with a student and need input, please call the Counseling Center. It is not always an immediate recognition with the non-emergency situations, but putting the pieces together later may inspire you to reach out.

If there are questions, call the TMCC Counseling Center (775-673-7060) for support for the person, and for yourself.

Privacy

Be aware of the person’s right to privacy. When possible, choose a time and location when you are able to talk to the person without disruption and in a private setting. Do not promise confidentiality to the person if their life is in danger.

Communication

Communicate with the individual; this may include:

• Asking the person what may be going on. The act of just asking may be helpful as it is showing a sense of concern and empathy.
• Listening to the person, allow them to talk and truly listen to them. This may be done by focusing on what the person is saying.
• Allowing the time for them to express what they are feeling without judgment. Do not rush them, give them this time to allow them to identify their feelings, such as loss, pain, sadness, anger and hopelessness. 
• Using active listening by using "I" statements, such as, "I hear you saying that..." which lets the person see that you are listening and you care.

What to Say

If you believe the person is at risk for self-harm and you do not feel comfortable addressing the concern directly, tell the student you are concerned and you want to help him/her get the assistance they need by connecting them to someone with more expertise.

• TMCC Counseling Center: 775-673-7060
• Crisis Support Services: 988

You can say something like the following: "I can call the Counseling Center (or Crisis Support Services) for you, or you can make the call yourself, what would you prefer?", or you can offer to walk the student to the TMCC Counseling Center.

If the student chooses to make the call, say: "I’m glad you are doing this. Here is the number, I’ll wait right here in case you need me."

If you believe the student is at risk for self-harm, and you feel comfortable probing, ask directly the following questions (note: You want to ask these questions, but be sensitive and open to exploring each. It should not be an interrogation):

• "Are you thinking of suicide?"
• If yes, follow with: "It sounds like you are in great pain, what is going on?"
• "Do you have a plan?"
• "Do you have the means to carry out the plan?"
• "Have you tried suicide before?"

Identify Student Resources

If the student is not in immediate danger, offer to help them identify resources:

• Provide the individual with the crisis support services number: 988.
• See TMCC Counseling Center Resources and Referrals.
• Ask the student what resources they may need to alleviate their distress. Focus on the person’s personal supports and their willingness to get the help needed to feel better. If possible, write down the student’s plan so they can share it with the counselor.
• Walk the student over to the Counseling Center for an appointment or call the Counseling Center at 775-673-7060.
• Follow up with the student to help ensure care was sought and provided.

Additional Considerations

When counseling students in acute and/or suicidal distress, cultural differences need to be taken into consideration. Recommendations for identifying, approaching, and providing successful assistance to students include but are not limited to:

• Developing an understanding of cross-cultural resources and awareness of intercultural communication styles by enhancing or expanding training offered. Being aware and examine your own stereotypes and bias. It is crucial that counselors develop cultural competency skills in order to best serve students.
• The DISCO (Diversity and International Student Center and Offices) is in RDMT 114 and is where a student can find resources from the Equity, Inclusion, and Sustainability Office and International Student Services.
• Immigrant Resources may have additional resources.
• Community Resources for Students has local and national resources for those with barriers.

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Suicide Attempt in Progress

The nature of a suicide attempt varies, but in each scenario it should be taken seriously as a threat to life.

In all cases, discretion should be taken to protect the person’s privacy, while also providing assistance immediately. Confidentiality does not apply in a situation in which a person’s life is in danger.

1. Call 911 (since University Police Department are on campus, they may be dispatched).
2. Provide first aid if necessary. 
3. Police will transport the person to the emergency room and will notify the TMCC Counseling Center of the situation.
4. Follow protocol for notifying emergency contact.
5. The Counseling Center will designate a counselor to follow up with the student and will offer services to those impacted by the suicide attempt.

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Attempted Suicide Off-Campus

If an attempted suicide is currently in progress off campus, call 911.

Persons who are aware of an off-campus suicide attempt by a TMCC student are strongly encouraged to notify the TMCC Counseling Center, the Student Conduct Office/University Police Department, and complete an electronic incident report.

The TMCC Counseling Center, or designee, will contact the student to initiate intervention and/or follow-up services as needed (and to ensure that a release of information is obtained by all agencies involved). The TMCC Counseling Center will provide referral services to the friends and family of the person and counseling and training to members of the TMCC community (students, faculty and staff) that have been impacted.

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Student Death

In a crisis, where a person’s life is at stake, the primary goal is to save the person's life.

If able to, the non-injured person should render first aid and/or call emergency medical assistance by dialing 911. Be aware of your exact location to assist medical and emergency personnel in finding you.

If the person is deceased, do not disturb the scene. If possible, secure and exit the scene while ensuring that it is not disturbed until medical or police arrive. If there are two people, one should stay at the scene while the other calls 911.

Discretion

Death can be traumatic for all people in the campus community. Until there is an official cause of death, labeling the death as a suicide or homicide may further complicate the matter.

Discretion must be used by the witnesses of an event regarding what is shared to non-emergency personnel.

Notification to the primary supports (i.e., family, friends and faculty) will be accomplished with discretion to protect the privacy of those directly involved. The Counseling Center will provide referral services to the friends and family of the person and counseling and training to members of the TMCC community (students, faculty and staff) who may have been impacted.

Notification of Emergency Contact

It is crucial that students maintain updated Emergency Contact Information. TMCC's Admissions and Records Office reminds students to update their emergency contact each semester at registration. In addition, advisors and counselors encourage students to update their information when they advise or counsel students.

In the case of student death: Notification will be accomplished by the coroner or the police department. A member of the campus administration will assist with the notification of on-campus death.

In the case of an emergency: A University Police Department officer trained in crisis intervention, or a counselor, will notify the emergency contact when a student is acutely distressed or suicidal. Only essential information will be revealed without the student’s informed consent.

For international students: Where language may be a barrier, translators will be secured to interpret for the emergency contact. The Northern Nevada International Center provides translation services in multiple languages and should be utilized when necessary to assist with notification to emergency contacts.

If you are first on the scene of a death, it can be traumatic and seeking help for yourself (even months later) is important. Counselors will be provided to facilitate grief processing to any person who is affected by the death.

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Post-Crisis Follow Up

TMCC Counseling Center Responsibilities

The Counseling Center will be notified of on and off-campus events and log the information into the secure counseling database. The Counseling Center will follow up with law enforcement, mental health facilities, emergency rooms, and other involved agencies to ensure TMCC Counseling Center services are included in post-crisis care when appropriate.

The Counseling Center will assign a counselor to facilitate follow-up planning when a student returns to school following hospital referral for mental health concerns. Follow-up planning will include:

• A review of the academic impact of recommended interventions,
• Identification of campus resources and support services that may be of assistance to the student.

Academic Options for Leave

Circumstances reasonably beyond the control of the student, which causes the student to be unable to attend classes, complete the semester, or otherwise become academically delinquent, may be a consideration for several academic options.

Several factors should be considered in the decision-making process. The student and counselor will review assessment and recommendations, student’s academic progress, and GPA. The student’s perspective and understanding of the problem, and timely reintegration will be addressed.

Counselors can provide guidance and facilitate discussions.

Documentation to substantiate the student’s claim requesting leave is required.

See the Admissions and Records Office Refund Policy Exception Request Form.

Requests are to be made in a timely fashion, when it first becomes evident that circumstances prevent a student from performing academically. Such circumstances include:

• An incapacitating illness or injury (e.g., psychological, medical) that prevents the student from returning to school for the remainder of the semester.
• Death of the student’s spouse, child, parent or legal guardian.
• Other exceptional circumstances beyond the student’s control.

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Admissions and Records Options

Incomplete

A temporary grade of incomplete (I) may be granted to a student at the end of the semester if the student is performing passing work in the course, and there are extenuating circumstances (beyond the student’s control) that prevent the student from completing the course requirements by the end of the instructional period.

• View information on incomplete grades in the current TMCC College Catalog
• Contact TMCC's Admissions and Records Office for more information

Audit

A student who wishes to enroll for no credit may register as an auditor.

View information on auditing in the current TMCC College Catalog

Withdrawal after the Drop Date

Students who wish to withdraw from a course(s) during the semester, and are no longer eligible for refunds based on TMCC withdrawal policy, can appeal the process.

See Refund Policy Exceptions for more information.

Students considering a complete withdrawal from all classes are strongly encouraged to contact the Financial Aid Office before withdrawing.

Contact TMCC's Admissions and Records Office for more information.