IDENTIFYING AND HELPING A STUDENT IN DISTRESS:
A GUIDE FOR FACULTY, STUDENTS, AND PARENTS
By John Mark Krejci, Ph.D.
University of Hawai¡®i at M¨¡noa
Experts state that, more and more, college students are suffering from depression, anxiety, and even suicidal thoughts and behaviors, among other difficulties. If you are not a mental health professional, you may not be aware of how you can help these students. This website offers some basic guidelines to help you identify, refer, and in some cases, personally assist students in distress.
What is a ¡°student in distress?¡±
¡°Distressed student" is a term used to refer to students who have become unable to adequately cope with the stressors upon them. Students like these may feel extremely overwhelmed, ¡°stressed,¡± and have persistent negative thoughts and feelings (e.g., they may feel hopeless, helpless, worthless, or uncared for¡ªthoughts and feelings associated with depression and suicidal thoughts). They may be experiencing clinically significant levels of depression, anxiety, and even suicidal thoughts/behaviors. These students may also be currently affected by a recent loss in their life (e.g., death of a friend or family member, break-up with a partner, etc.), or are close to someone who may be going through a loss. They may be affected by a traumatic past experience.
How will I know a student is in distress?
Students may not tell you that they are having difficulties; however, their distress may take other forms that are recognizable. Below are some possible indicators you may notice in a distressed student: 
Marked Decline in Academic Performance or Behavioral Changes
Poor performance and preparation
Failure to turn in assignments
Excessive absences or tardiness
Repeated requests or special consideration, especially when this represents a change from previous functioning
Withdrawal from class participation
Unusual comments/speech in discussions
Excessively anxious when called upon
Excessive or inappropriate anger
Exaggerated emotional response that is obviously inappropriate for the situation
Possible alcohol/drug use
Unusual Behavior or Appearance
Depressed or lethargic mood
Hyperactivity or very rapid speech
Change in personal hygiene, dress, or general appearance
Dramatic weight loss or gain
Strange or bizarre thoughts/behavior indicating possible loss of contact with reality
References to Emotional or Life Stressors
Problems with roommates, family or romantic partners
Experiencing a death of a significant other
Experiencing a physical or sexual assault
Experiencing discrimination based on gender, race, religion, ethnicity, sexual orientation, or disabilities
Experiencing legal difficulties
Any other problem or situation that is experienced as stressful or a loss
References to Suicide, Homicide, or other thoughts of Death
Feelings of helplessness, hopelessness, and worthlessness
Verbal or written references to suicide
Isolation from friends, family, and classmates
Other possible ways to identify a distressed student...You may be able to identify a distressed student by the reactions you have to them, such as the following:
Feeling uncomfortable about a student¡¯s comments or behavior
Concern about a student¡¯s ability to function
Feeling alarmed or frightened
What Can I Do To Help? 
Distressed students generally benefit from counseling or psychotherapy with a trained professional. In fact, studies have shown counseling to lead to satisfactory outcomes for approximately 75% of clients. Many UH students, however, may not be aware of the free and confidential counseling services available to them at the CSDC.
With a distressed student, we recommend that you refer and, if feasible, walk the student to the counseling center. If the student seems to want to talk to you or it appears you may need to talk to the student before convincing them to come to the counseling center, you may choose to utilize some of the following skills:
LISTEN, LISTEN, AND LISTEN SOME MORE¡ªListening is often the most useful and under-utilized skill to use with someone in distress. The art of listening and ¡°being there¡± for someone who needs help may be all that is necessary for the student, particularly if they are unwilling to talk to a counselor.
How can I be a better listener?
MEET with the student when both of you have the time and are not rushed or preoccupied. Give the student your undivided attention. It is possible that just a few minutes of effective listening on your part may be enough to help the student feel cared about as an individual and more confident about what you do.
BE NON-JUDGMENTAL If you have initiated the contact, express your concern in behavioral, nonjudgmental terms. For example, "I've noticed you've been absent from class lately and I'm concerned," rather than "Where have you been lately? You should be more concerned about your grades."
LISTEN to thoughts and feelings in a sensitive, non-threatening way. Communicate understanding by repeating back the essence of what the student has told you. Try to include both content and feelings, ("it sounds like you're not accustomed to such a big campus and you're feeling left out of things."). Let the student talk.
Use ¡°Minimal Encouragers¡±: A minimal encourager is a fancy term for a simple technique many people naturally use. Minimal encouragers are the sounds made to let someone know you¡¯re there and listening. Generally, they are short statements/questions such as ¡°Uh-huh,¡± ¡°Mm-hmm,¡± ¡°Oh?,¡± ¡°When?,¡± ¡°Really?,¡± etc. They are sounds/gestures that do not interfere with the flow of conversation but do let the person know that you¡¯re there and listening. Minimal encouragers are useful because they help build rapport and encourage the person to continue talking.
Use ¡°reflection¡±/paraphrase what the student is saying to you: Reflecting the students¡¯ statements can help them feel listened to, understood, and cared for. Reflections often start with phrases like:
¡°It sounds like¡¡±
¡°I hear that¡¡±
¡°It seems like¡¡±
VALIDATE the student¡¯s feelings:
"It sounds like you are going through a real tough time right now."
"I can/can¡¯t imagine how hard it must be for you right now (Be authentic)."
to help you get through this if I can."
INSTILL hope. Assure the student that things can get better. It is important to help them realize that there are options, and that things will not always seem as hopeless. In almost all cases, mental health conditions respond to treatment over time. Without instilling false or premature hopes, you can help the student to know that they will not always feel as bad as they do now, and that help exists. Suggest resources: family, friends, clergy, coaches, counselors, or other professionals on campus. Recognize, however, that your purpose should be to provide enough hope to enable the student to consult a professional or other appropriate person and not to solve the student's problems. You can tell the student that counseling center offers free and confidential services to students, and that there are mental health practitioners that are trained to help and that care about their well being.
AVOID judging, evaluating, and criticizing. This is important even if the student asks your opinion. Such behavior is apt to push the student away from you and from the help that he or she needs. It is important to respect the student's value system, even if you do not agree with it.
MAINTAIN clear and consistent boundaries and expectations. It is important to maintain the professional nature of the faculty/student or staff/student relationship and the consistency of academic expectations, exam schedules, etc. You may be able to help a student understand their options related to a deferred grade (i.e., taking an ¡°incomplete¡±), late drop or withdrawal from the semester. If a student seems to feel overly distressed about making a decision, counseling may be particularly helpful to them.
REFER them to resources that can help. In making a referral, it is important to point out that: 1) help is available; and, 2) seeking such help is a sign of strength and courage rather than a sign of weakness or failure. It may be helpful to point out that seeking professional help for their problems is considered good judgment and an appropriate use of resources. If you can, prepare the student for what they might expect if they follow your suggestion. Tell them what you know about other options on campus (¡°There is a office at UH called Counseling and Student Development that offers free and confidential, personal and career counseling for UH students.¡±)
TIME your intervention. It is important to be aware that options for referral vary depending on the time of day. The Counseling and Student Development Office is open Monday through Friday from 8:00 a.m. to 4:30 p.m. for crisis intervention as well as appointments.
*** All UH-system students have free access to counseling services at Counseling and Student Development Center ***
After hours and on weekends, students (who live in the residence halls) who are in crisis can talk to a resident assistant (RA), who may contact a counselor-in-residence (CIR); an on-call counselor is available 24 hours a day, seven days a week to help students in crisis outside of counseling center hours. They are typically able to be ¡°on the scene¡± to talk to the student within 15 minutes of being paged by the RA.
FOLLOW-UP Have a meeting with the student again in person (or on the phone) to help solidify their resolve to obtain appropriate help and to demonstrate your commitment to assist them in this process. Check later to see that the referral appointment was kept and to hear how it went. Due to confidentiality, the counseling center may not be able to tell you if the student made/kept an appointment, but you yourself may ask the student if he/she saw a counselor. We also welcome any pertinent information you can give us about a student for whom you have concerns. If possible, provide support while the student takes further appropriate action or pursues another referral (e.g., student decides to see a therapist in the community), if needed.
CONSULT When in doubt about the advisability of an intervention, contact Counseling and Student Development at 956-7927. After hours and on weekends, please call (808) 832-3100 or 911, in an emergency.
 http://news-info.wustl.edu/tips/page/normal/4198.html, Depression, suicide are the major issues facing college students, says student health director, Washington University.
 http://pennstatebehrend.psu.edu/student/counseling/distress.htm, Students in Distress: A guide for faculty and staff. Penn State Erie, The Behrend College,
 http://www.sa.ucsb.edu/distressedstudentsguide/Protocol/index.aspx, Responding to Distressed Students-University of California, Santa Barbara
 Kitaoka, S., Krejci, J.M., & Khen, S., Student Housing RA Training: Communication & Peer Counseling, University of Hawai¡®i at M¨¡noa.
 http://pennstatebehrend.psu.edu/student/counseling/distress.htm, Penn State Erie, The Behrend College, Students in Distress: A guide for faculty and staff