Mental Health or Just Immaturity? Recognizing Unhealthy Behaviors and Helping Students Find the Resources They Need

Psychology professor Dr. Mary McNaughton-Cassill discusses why educators may inadvertently overlook mental health problems among students.

I remember the interaction vividly. I was teaching Abnormal Psychology, and in my section, I had one of those “premed-type students” who was used to nothing but As. He argued for points after every exam. It drove me crazy.

On the day I lectured on Obsessive Compulsive Disorder (OCD), he approached me after class. He told me that the lecture I had just given explained his whole life. It turned out that he was unable to stop obsessively rechecking numbers, whether it was a test score or his checkbook. A few months later, he returned to tell me that he was in counseling and was feeling much better.

I wish that, before he told me this, I could have handled the situation better or even considered the possibility that what drove him was more than a quest for good grades. But I’m not unusual. Most college professors—even in psychology—receive little formal training in classroom management. Many faculty members find themselves at a loss when dealing with a student who is disruptive, disrespectful, angry, excessively anxious, or irrational. Sometimes the behaviors are the result of immaturity or poor social skills, and in other cases they are triggered by academic stress and, in particular, disputes about grades (Tantleff-Dunn et al. 2002). A relatively new source of faculty stress involves phones in the classroom—“electronic incivility”—which provides increased opportunities for distraction and disruption (Nworie and Haughton 2008).

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From discussions with colleagues, I’ve found that many of us assume students’ problem behaviors stem from immaturity or overdependence on parents. But, in some cases, mental illness is the cause. In a 2017 survey of first-year students at UCLA, 12% of students reported frequent depression, and 35% said they were frequently anxious (Eagan et al. 2017). An American College Health Association survey (2018) reported that 64% of students said they had experienced overwhelming anxiety in the past year. Even more disturbing, more than 1,000 college students a year commit suicide in the United States (Fernández and Huertas, 2013). The stress of leaving home, going to school, establishing a social life, and failing to take medication can exacerbate mental health issues, particularly during the early years of a student’s college career. And, according to the JED Foundation, rates of depression and anxiety have risen significantly in the past two decades.

So how do we differentiate between bad manners and mental health issues? While it is always important to take into account individual circumstances and context, a number of behaviors and signs can indicate that a student is experiencing mental health difficulties. Some signs are vivid. For example, excessively strong or inappropriate emotional responses, poor impulse control, disorganized speech or thoughts, or evidence of hallucinations (such as hearing voices) can be disturbing and difficult to manage. Severe depression or anxiety, bipolar disorder, and schizophrenia can all impair an individual’s perceptions of reality and ability to function, and often emerge in the teen or early adult years (Stringer, 2016).

But symptoms of mental distress may be harder to see—or subject to misinterpretation. For example, an instructor might attribute memory and attention problems to lack of interest or laziness when, in reality, depression often impairs the ability to focus and retain information. Changes in behavior, such as poor hygiene or absenteeism, in a formerly responsible student might look like “senioritis” when in fact they are indicative of deteriorating mental health. Arguing about a grade or asking for absence leniency may look like hostility or manipulativeness when, in fact, it is due to anxiety or post-traumatic stress disorder (PTSD).

Perhaps most disturbing of all are self-injurious behaviors—such as self-cutting (Heath et al. 2008), disordered eating (Eisenberg et al. 2011), substance use (Lipari and Jean-Francois, 2016), or suicidal threats or attempts (Liu et al. 2018). While evidence of self-harm may not always be visible, these students often make concerning comments in person or via written comments in email, class-related chat rooms, or social media. We can’t ignore these actions. When students show concerning behavior, faculty have both an ethical and a legal obligation to seek help for that student and should always consult with mental health specialists on campus.

In a media-driven world where mass shootings and scandals tend to draw sustained attention, faculty often worry about being harmed by disaffected students. Behaviors that threaten others—anything from harassment and assault to stalking or threats of large-scale violence—cause stress and fear across campus. While the reality is that people who suffer from mental illness are more likely to be harmed by others than to be violent themselves, and the overall risk of violence in the classroom is statistically low, people with untreated mental illness can pose a risk (Ponsford, 2016). When you trust your intuition, work to create a campus culture that encourages people to speak up about concerns, and collaborate with your campus behavioral intervention team, you increase your sense of control and safety.

As faculty members who spend a great deal of time working with young adults who are at risk for high levels of stress and mental illness, the onus is on us to educate ourselves about the signs of mental illness. We need not be able to diagnose or treat our students, but we need to know how to recognize signs of mental distress, understand whom to call for help, and be comfortable enough to stabilize the situation until the experts arrive. Rather than worrying about concealing signs of mental illness, or labeling people because they seek therapy, we need to find ways to convince people that shame doesn’t lie in admitting to mental distress and that ignoring or denying signs of treatable conditions will not make them go away. We cannot wait for institutional policies and support.

Readings

American College Health Association–National College Health Assessment II: Undergraduate Student Reference Group (https://www.acha.org/documents/ncha/NCHA-II_Spring_2018_Undergraduate_Reference_Group_Executive_Summary.pdf). Spring 2018.

Conley, C., J. Shapiro, B. Huguenel, and A. Kirsch. “Navigating the College Years: Developmental Trajectories and Gender Differences in Psychological Functioning, Cognitive-Affective Strategies, and Social Well-Being” (https://www.researchgate.net/publication/327248350_Navigating_the_College_Years_Developmental_Trajectories_and_Gender_Differences_in_Psychological_Functioning_Cognitive-Affective_Strategies_and_Social_Well-Being). Emerging Adulthood, August 2018.

Cook, L.M. (2007) “Striving to Help College Students with Mental Health Issues” (https://www.ncbi.nlm.nih.gov/pubmed/17477328). Journal of Psychosocial Nursing and Mental Health Services, vol. 45, no. 4, April 2007, pp. 40–4.

Duran, R.L., L. Kelly, and J.A. Keaten. “College Faculty Use and Perceptions of Electronic Mail to Communicate with Students” (https://www.researchgate.net/publication/228342648_College_Faculty_Use_and_Perceptions_of_Electronic_Mail_to_Communicate_with_Students). Communication Quarterly, vol. 53, no. 2, 2005, pp. 59–76.

Eagan, M.K., E.B. Stolzenberg, H.B. Zimmerman, M.C. Aragon, H. Whang Sayson, and C. Rios-Aguilar. The American Freshman: National Norms Fall 2016 (https://www.heri.ucla.edu/monographs/TheAmericanFreshman2016-Expanded.pdf). Los Angeles: Higher Education Research Institute, UCLA, 2017.

Eisenberg, D., E.J. Nicklett, K. Roeder, and N.E. Kirz. “Eating Disorder Symptoms Among College Students: Prevalence, Persistence, Correlates, and Treatment-Seeking” (https://www.tandfonline.com/doi/abs/10.1080/07448481.2010.546461). Journal of American College Health, vol. 59, no. 8, 2011, pp. 700–707.

Fernández R. and I.B. Huertas. “Suicide Prevention in College Students: A Collaborative Approach” (https://journal.sipsych.org/index.php/IJP/article/download/201/pdf). Revista interamericana de psicologia (Interamerican journal of psychology), vol. 47, no. 1, 201, pp. 53–60.

Heath, N.L., J.R. Tote, T. Nedecheva, and A. Charlebois. “An Examination of Nonsuicidal Self-Injury Among College Students” (https://www.researchgate.net/publication/277909659_An_Examination_of_Nonsuicidal_Self-Injury_Among_College_Students). Journal of Mental Health Counseling, vol. 30, no. 2, April 2008.

Lipari, R.N., and B. Jean-Francois. A Day in the Life of College Students Aged 18 to 22: Substance Use Facts (https://www.samhsa.gov/data/sites/default/files/report_2361/ShortReport-2361.html). The CBHSQ Report (Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD), May 26, 2016.

Liu, C.H., C. Stevens, S.H.M. Wong, M. Yasui, and J.A. Chen. “The Prevalence and Predictors of Mental Health Diagnoses and Suicide Among U.S. College Students: Implications for Addressing Disparities in Service Use” (https://onlinelibrary.wiley.com/doi/full/10.1002/da.22830). Depression and Anxiety, September 2018, pp. 1–10.

Nworie, J., and N. Haughton. “Good Intentions and Unanticipated Effects: The Unintended Consequences of the Application of Technology in Teaching and Learning Environments (https://link.springer.com/article/10.1007/s11528-008-0197-y). TechTrends, vol. 52, no. 5, 2008, pp. 52–57.

Ponsford, L.R. “Assessing Mental Health and Violence on College Campuses Using the Vulnerability Model” (https://onlinelibrary.wiley.com/doi/full/10.1002/2327-6924.12351). Journal of the American Association of Nurse Practitioners, vol. 4, April 2016, pp. 212–217.

Rieck, S. and L. Crouch. “Connectiveness and Civility in Online Learning” (https://www.researchgate.net/publication/6075444_Connectiveness_and_civility_in_online_learning). Nurse Education in Practice, vol. 7, no. 6, 2007, pp. 425–432.

Rössler, W. “The Stigma of Mental Disorders: A Millennia-Long History of Social Exclusion and Prejudices” (https://www.embopress.org/doi/full/10.15252/embr.201643041). EMBO Reports, vol. 17, no. 9, 2016, pp. 1250–1253.

Stringer, H. “Catching Psychosis Early” (http://www.apa.org/monitor/2016/10/psychosis). Monitor on Psychology, vol. 47, no. 9, October 2016.

Tantleff-Dunn, S., M.E. Dunn, and J.L. Gokee. “Understanding Faculty-Student Conflict: Student Perceptions of Precipitating Events and Faculty Response” (https://www.researchgate.net/publication/247504933_Understanding_Faculty-Student_Conflict_Student_Perceptions_of_Precipitating_Events_and_Faculty_Responses). Teaching of Psychology, vol. 29, no. 3, 2002, pp. 197–202.

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