Editor’s Note: This is part eight in our mental health series "Talk about it.” Sensitive content may follow.
A crisis can be different for everyone, but overall it is a response to an event where an individual needs immediate support, said Student Counseling Services (SCS) director Christopher Hanes.
“So it’s really something that’s so upsetting to the person that they don’t feel they can keep themselves or other people safe or they just don’t feel emotionally safe,” said Sue Reimers, clinical care coordinator for SCS.
Several offices within Iowa State and Ames play a role in helping students through these experiences.
The Office of Student Assistance is under the Dean of Students and exists to provide support and information about university resources. If a student faces unexpected challenges such as life events, academic difficulties or personal crises, the Office of Student Assistance is the liaison between students and faculty.
“There are a million and one resources on the college campus and it can sometimes be really, really difficult to know where to start and so our office really wants people to know that they can start here,” said Megan Van Heiden, senior assistant director for the Office of Student Assistance.
Student Assistance will have direct contact with the student in a crisis situation, meaning they will have the most check-ups, follow ups and help them figure things out from there on. They will be the ones who connect and communicate with the necessary people about the event.
“We send what’s called ‘the notification’ from our office and that’s sent all of the student’s instructors,” Van Heiden said. “We try to work with students to determine what language they feel comfortable with us sharing […] and really leave that up to the student to determine how much or how little.”
Throughout the time that the student is gone, the Office of Student Assistance will maintain communication between the student and their professors. When meeting with the student, using language which validates the students experience has helped in situations, Van Heiden said.
“I really try to use empathy and getting a sense of connection with someone — seeing their ability to be vulnerable and sharing something deeply personal with someone that they just met that can be incredibly challenging,” Van Heiden said. “So by validating, to me what I mean when I say that, is if a student shares with me ‘I’m having a really hard time and here are the reasons why’ and saying ‘you’re right, that does sound incredibly challenging.'”
If a student needs to take time off from school, they could apply for a medical withdrawal which includes mental and physical health. The student speaks with their academic adviser about the options in regards to a medical withdrawal form. Student Assistance can help with this and they also help students come back to school after taking that time off.
Iowa State Police Department and welfare checks
If a student, family or faculty is concerned about an individual, they can contact the Iowa State Police Department (ISUPD) to do a welfare check. The officer on-call will go the student’s dorm or a place where they are most likely to be and check-in, ask a few questions and determine the risk.
“It just depends on the situation and the student," said Kinsey Phillips, mental health advocate for ISUPD. "Sometimes we might start with a student who needs resources on campus but doesn’t need them immediately, maybe they’re not in crisis in that moment and they aren’t having thoughts of self-harm or suicide.”
In 2018 there were 287 welfare checks, according to the Iowa State Annual Police Report.
The calls can be made through ISUPD or they can call the Central Iowa Crisis line to get a Mobile Crisis Team, a group of professionals who can provide onsite, face-to-face mental health services.
If the student is calling 911 for a mental health emergency, letting the dispatcher know a crisis intervention team officer is needed, as well as requesting if it is possible to arrive without lights and sirens. Depending on the case and situation, taking away the lights and sirens could help the student.
If the student is actively suicidal when officers arrive for the welfare check, they are taken immediately to the hospital or crisis counseling, Phillips said. During the welfare check, the officers will provide resources to the students and will always be followed up by Student Assistance, if the student is not actively suicidal.
Phillips said she does not go on every welfare check but follows up with the students and makes sure they get an outreach.
“I would send [the welfare check] to our team and make sure that everyone was in the loop of what happened and that person would get an outreach […] it’s always going to be from Student Assistance,” Phillips said. “I also will outreach to students and say ‘do you want to come in and talk about resources or do you just want to come in and see Zosia?’"
Zosia is a certified therapy dog and helps comfort the student, Phillips said.
When checking in on the individuals, the police try to be out of uniform and in everyday clothes to make the individual feel more comfortable, Phillips said. Depending on the situation, students can be taken to SCS for crisis counseling.
Student Counseling Center
Everyday there is an on-call crisis team at SCS and the student will immediately meet with a therapist from that team who will assess the situation. This can include a risk analysis, developing a self-care plan and analyzing the factors that caused the student to go into a crisis situation.
SCS has a walk-in triage which includes the crisis services.
“One of the things that I remind them is that we’re going to work on coming up with a plan for them to feel better or safer, depending on what their issue is, and this isn’t really a counseling appointment and it’s not getting them set up in services in counseling but rather we’re just here working on the immediate need,” Reimers said.
This time will be spent supporting the student as well as consultation done behind the scenes with other therapists.
“We’re a team here, so often times with students in crisis there’s consultation time as a team,” Hanes said. “Sue would step out and talk about the case with another licensed person, another staff member, to review the case so there’s the ability for multiple people to give perspective and ideas.”
The therapist will also start a stabilization process which starts with helping the individual feel safe and out of the crisis, after they will create a self-care plan until they are able to come to a walk-in service and schedule follow-up appointments.
“Whenever a student comes through [SCS], an absolute important part of the process is the talk through; kind of what brings them in [...] occurring concerns and how they’re functioning around those concerns,” Hanes said. “We talk to them about increasing awareness on what might be some of their challenges, what might be some of their signs that they’re struggling more or they’re not doing well, we really try to empower them to partner with us on monitoring.”
If the student is an existing client, they would come up with a plan with their current therapist.
Hanes and Reimers said the crisis counseling tends to spike during the beginning, middle and end of the year, though students going to the hospital because of a crisis is not as common.
Going to the hospital
In the situation the student needs to go to the hospital, they would go to the Behavioral Health Unit at Mary Greeley Medical Center. On the way to the hospital or at the waiting room, Phillips said she will have conversations with the student ranging from small-talk to a rundown of what to expect.
“I don’t go to the emergency department all the time […] it’s just kind of nice to be able to sit with someone,” Phillips said. “I know that if I were in their shoes, I would be a little scared and I would want someone to be with me.”
Once the student arrives, a general and mental health assessment will be conducted which will include medications and treatment history as well as what brought them in. According an article on Mary Greeley's website, the information that is gathered during the first 24 hours is critical for the staff to create a treatment plan.
“You need to glean the story. One of the huge challenges for psychiatric patients is continuity and consistency of care,” said Christine Krause, director of Behavioral Health Services.“We want to establish what their care environment has and hasn’t been. We really try to be diligent to figure out where they’ve been, what’s been going on, and what we can do to do what’s right for them. Maybe something hasn’t been working. Maybe they haven’t been compliant. So do we need to change something or start more intensive case management? It’s so important to create that patient’s story.”
There are two areas in the Behavioral Health Unit: a four-bed high-acuity unit and a 14-bed general unit. According to the article, the floor is decorated in neutral colors and there are no thumb tacks in bulletin boards or glass in picture frames in order to ensure safety.
While the student is there, someone from Student Assistance will check in on the individual and help determine their needs.
“We try to have communication with students when they’re in the hospital,” Van Heiden said. “So whether that’s [on the] phone or one of our staff goes to the hospital and [asks] ‘What are the immediate concerns or questions you may have, what can we help facilitate for you right now?’ and we always set up a follow up appointment for when they’re released from the hospital."