Guidelines for Identifying and Referring the Distressed Student

Critical Assistance: Psychological Counseling Services
PCS drop-in hours are M-F 10-11:30am and 1-2:30pm. (In an emergency, between 8am and 5pm.)  Drop-in hours in the satellite clinic in the Student Union M-Th from 5-6:30 pm. The Center is staffed by professional psychologists, psychiatrists, social workers, and trainees. Call  278-6416.

Topics on page

Signs of Stress
    A Stated Need for Help
    Unusual Changes in Behavior and/or Mood
    Rapid Onset of Physical Illness
    Traumatic Changes in Personal Relationships
    Alcohol and Drug Abuse/Dependence
    References to Suicide

Faculty and Staff Interventions
    Emergency Situation – Imminent Threat of Harm
    Emergency Situation – Recent Threat of Harm
     How to Help a Student Under Stress
    Means of Coping With Stress
     How to Refer a Student for Further Help
        When to Refer
        To Whom to Refer
        How to Refer
        Information for person being referred

Signs of Stress

The following signs, depending on their severity, usually indicate that a student is under some degree of stress and may need help. A single sign in a very pronounced state, or a cluster of signs appearing about the same time, would probably indicate the need for a referral to Psychological Counseling Services.

    A Stated Need for Help

The need may be stated directly or indirectly, strongly or modestly. It is important not only to hear what the student is saying, but also to notice how he or she is saying it.

    Unusual Changes in Behavior and/or Mood

    Rapid Onset of Physical Illness

    Traumatic Changes in Personal Relationships

    Alcohol and Drug Abuse/Dependence

    IN CASE OF A DRUG OVERDOSE, CALL 911 IMMEDIATELY.

    References to Suicide

If you listen carefully, it is often possible to distinguish between a "theoretical" discussion of suicide and the personal anguish of "not knowing if life is worth the hassle." Regardless of which is the case, it would be helpful to talk with a student who makes such reference. IMMEDIATE referral is necessary if the conversation includes the how, the when, and/or the where of the suicide. During the hours of 8:00 a.m. until 5:00 p.m., please call 278-6416. After hours, call public safety 8-6851.

IN CASE OF ATTEMPTED SUICIDE, CALL 911 IMMEDIATELY.

Faculty and Staff Interventions 

    Emergency Situation – Imminent Threat of Harm

If a faculty or staff member has knowledge of or observes very unusual behavior, including, but not limited to:

If medically stable, Public Safety psychological will transport to the hospital or determine a plan of transport.

        Emergency Situation – Recent Threat of Harm

If a faculty or staff member learns that a student has been talking about harming himself, herself, or others, and/or engages in any type of self-destructive or psychotic behavior, he or she should consult with Psychological Counseling Services.   

    How to Help a Student Under Stress

  1. Be available.
  2. When you talk with a student, put aside all other work in order to give him or her 100% of your attention.
  3. Listen with care, attention and acceptance from the student’s perspective, rather than your own. Develop an "adult-adult" approach rather than a "superior-subordinate" approach. Use reflective statements, i.e., share with the student what you hear him or her saying.
  4. Help the student define what is causing the stress, the effects of the stress, what he or she is doing to cope and how effective the coping skills are.
  5. Before offering suggestions or advice, encourage the student to think of coping methods he or she has found effective in the past or which might be effective in dealing with the current stressors. Doing so empowers the student to rely on his or her own judgment and to assume responsibility.
  6. After the previous items have been discussed, you can suggest alternative ways of viewing the situation and other ways of coping with or minimizing the stress. (See the "Means of Coping with Stress" part of this material.)
  7. Take the time to follow up with the student, i.e., asking generally how the student is getting along. Do so in an interested, concerned and adult-adult manner, not in a paternal manner.
  8. If it seems that the student has made little or no progress with resolving the stress situation or employing various coping mechanisms, refer the student to Psychological Counseling Services or to other appropriate resources on or off campus.
  9. Don’t hesitate to call one of us at PCS or another referral source to discuss a student’s situation. In that way, not only will you help the student deal more effectively with the problem, but you will also prevent the possibility that you will become part of the student’s problem. It is more beneficial to the student if you are aware of your limitations and, thus, know when and how to appropriately access referral sources.

    Means of Coping With Stress

  1. Eat a balanced diet, get a good night’s rest, and exercise regularly. Get regular physical examinations. When we feel "good," we not only are able to deal with problems more effectively, but also to interpret problems as less severe.
  2. Set realistic academic and personal priorities, and reevaluate them periodically. Don’t overload yourself with unimportant responsibilities or tasks. Be flexible!
  3. Do as much as you can appropriately and effectively each day about the stress-producing situation. Then, consciously discipline yourself to believe the fact that you have done your best today and stop worrying about the future which you can no longer affect this day.
  4. Don’t wait until the last minute to do things! Plan your day and week so that you are able to accomplish the necessary tasks and comprehend all the responsibilities and activities that lie before you.
  5. Consider alternative ways of viewing your situation. Sometimes it is not the situation but the particular way you interpret it that creates undue stress. This is essential if you happen to be the "catastrophizing" type of individual, i.e., one who often interprets events or problems as crises.
  6. Try at various times each day to "get outside yourself," i.e., listen to and concentrate on others and think about other external events. Constant preoccupation with oneself is sometimes quite counter-productive.
  7. Balance your social time with some alone time. Experience what it means to feel good about being yourself.
  8. Engage in prayer or meditation.
  9. Read self-help books that address the area of life that is causing you stress. Psychological Counseling Services can recommend books that are used in conjunction with counseling.
  10. Learn effective relaxation exercises through books, tapes or classes.
  11. Learn more productive reading and study skills. Visit the Center for Teaching and Learning in Lassen Hall.
  12. Engage in individual activities that are pleasurable and provide a diversion, such as TV, hobbies, reading, exercising, going to a movie, play, or concert, listening to or playing your favorite music, hiking, eating out for a change, etc.,
  13. Be aware of your support system: friends, family members, professors, counselors, etc., and be willing to ask them for help.
  14. Attend the church or synagogue of your choice, or talk to a minister, priest, or rabbi.
  15. Get involved in volunteer work or do something helpful for someone you know.
  16. Learn about the campus resources that are available to you. Refer to the student handbook or consult with fellow students.
  17. Be careful not to fall into the trap of thinking and feeling that you are "all right" only when everyone else "approves" of you.
  18. Engage in social diversionary activities like athletics, dancing, participating in social, special interest, or religious groups, taking short trips, playing games, etc.,
  19. Be selective about the people with whom you choose to share your concern. Talk to trusted, mature, and experienced people who may have dealt with concerns similar to yours, or who can offer honest, responsible feedback. They can sometimes give tips and perspectives that can help you accomplish a task or deal with a situation, thus, reducing the stress and anxiety you feel.
  20. When given advice, always remember that you are not obligated to follow it; after all, you are ultimately responsible for yourself, and what happens to you. Learn to rely on your own judgment and remember this takes practice and patience with yourself.  

    How to Refer a Student for Further Help

    When to Refer

  1. When a student presents a problem or a request for information that is beyond your level of competency.
  2. When you feel that personality differences (which cannot be resolved) between you and the student will interfere with his or her effective progress.
  3. If the problem is personal and you know the student on other than a professional basis (friend, neighbor, etc).
  4. If the student is reluctant to discuss his or her problem with you for some reason.
  5. If, after a period of time, you do not believe your work (communication) with the student has been effective

Don’t wait until it is too late for anyone to help! Anyone able to identify situations that need specialized counseling or advising deserves commendation.

    To Whom to Refer

Knowledge of persons, offices and agencies that can be of service to you and the student is of primary importance. You’ll want to be sure to refer the student to the persons or office that will best serve the student. We all know how discouraged we get when we are passed along from office to office without a real effort on anyone’s part to determine where we can receive the help we need. If you are not sure where to refer the student, find out before you send the student off with assurance that he or she will find help.

    How to Refer

  1. Build rapport with the student. Let the student express his or her feelings, and if necessary, calm down. This step may include a statement of your intention to help and observation and identification of his or her feelings (e.g., "You seem afraid. Your voice is trembling and you hands are shaking.").
  2. Determine the problems, how long they have existed, which problem is most pressing, and the student’s resources, (e.g., the student’s success in resolving similar problems, the availability of friends, family, etc). If the problem appears serious and longstanding and the student does not have or want to use his or her human resources, a referral is appropriate.
  3. Making the Referral
  1. Ask the student what he or she sees as a solution to the problem. He or she may come up with an acceptable solution or suggest the need for outside help. The latter makes the process of referral easier, while the following steps are suggested if the student has not considered a referral or seems reluctant to access outside help.
  2. Re-summarize the problem, noting its magnitude and duration.
  3. Raise the issue of seeking outside help.
  4. Assess the student’s reactions to this suggestion.
  5. Ask the student which outside source he or she sees as most appropriate for dealing with this problem.
  6. If the student is unaware of sources of help, suggest in a caring, concerned, and forthright manner the most appropriate service or person. Describe what the agency is like.
  7. Observe the student’s reactions to the referral, and answer questions he or she may have about the referral. Convey positive but not exaggerated expectations of help from the referral, and deal with their fears about contacting this helping source.
  8. Specify the procedures involved in contacting the agency, including who, when and how of making the referral, or allow the student to use your phone to arrange the appointment. Making his or her own appointment reinforces the student’s sense of self-responsibility.
  9. If you have information about the student that you feel is important to share with the counselor, don’t share it in front of the student. Always secure the student’s permission before passing information about the student on to the counselor.
  10. Solicit agreement from the student to follow through on the referral.
  11. Encourage the student to act upon the referral.
  12. Check with the student to see if the referral was followed up, and is working out. Don’t pump the student for information. If you inquire as to whether or not the student kept the appointment, the student will volunteer whatever information is necessary to continue your relationship.
  13. The person making the referral cannot expect to be provided with the details of treatment, or share the confidences given by the student to the counselor. You can expect to receive consultation on how best to interact with the student in future relationships if this information is so desired or necessary. Always feel free to call the counselor for this consultation.
  14. Don’t expect the immediate resolution of particular symptoms or problems. It may be a process that moves slowly.
  15. Finally, respect the individual. The basic approach to all counseling and referral is one of fundamental respect for the individual, and the belief that it is best for that person to work out his or her problems in an individual way. You and the counselor are helpers in this process by providing a variety of alternatives for assistance on the student’s own terms. He or she may choose to ignore or accept the help available. Your role is to see that the student becomes aware of this help and has the maximum opportunity to utilize it.

Referrals to Psychological Counseling Services

Here is some information about our Center that may help you when making referrals. We are located on the 2nd floor of the Student Health Center. We offer individual, couple and group counseling for Sac State students with personal, educational or vocational concerns. We also provide psychiatric services (medication), biofeedback, and Learning Disorders Testing.

Our drop-in hours are M-F 10-11:30am and 1-2:30pm. (In an emergency, we can see students at other times between 8am and 5pm.) We also have drop-in hours in our satellite clinic in the union M-H from 5-6:30. The Center is staffed by professional psychologists, psychiatrists, social workers, and trainees. We can be reached at 278-6416. Please do not hesitate to call the Center to determine if a referral is appropriate. We are here to help!

The following information should be explained to students when you are referring them to the Center:

If you send over a student, please call us to let us know the student is on their way. If you consider the situation to be a serious one warranting immediate intervention, then tell the receptionist that this is a crisis situation. Such crises are responded to immediately. In such a situation, you may want to walk over with the student.

Counseling and Psychological Services 278-6416

2nd Floor, Student Health Center

2007  Sacramento State Psychological Counseling Services.

This guide is adapted from a similar guide at Southern Methodist University.