Counselors As Mental Health Consultants

Sharon Mitchell, Jessalyn Klein, & Brad Linn

University at BuffaloCounseling Services

Introductions

• Introduce presenters & context

Learning Objectives

• Understand types of mental health consultation taking place on a college campus

• Name most common concerns consultees bring to counseling centers

• Obtain recommendations for more effective consultations

Roles and Function of College Counseling Centers

• Counseling (individual, group, couples, family)

• Prevention & education• Training• Mental Health Consultation (growing

role)

Mental Health Consultation Assumptions

Consultation is: • a problem solving & educational process• dyadic or triadic• voluntary• collaborative• temporary• focused on mental health problems

Adapted from Michael Dougherty (2009)

Assumptions cont’d.Consultation:• helps both Consultee & Person of Concern

(POC)• is a relationship in which Consultant has no

control over Consultee’s actions• is a situation where Consultant may/may

not have direct contact with POC• entails working with Consultee to enhance

Consultee’s effectiveness in assisting POC

Venues for Consultation on a College Campus

• After hours On-Call Crisis Intervention

• Students of Concern (SOC)/Behavioral Intervention/Threat Assessment Team

• External Consultations: Phone, e-mail, or face-to-face contact with concerned others (family, friends, faculty, staff)

How Was On-Call Service Used?

• Total number of calls: 58• Total number of consultees: 41 people*• Average call length: 28 minutes, range

8-125 minutes• Most consultees were students seeking

assistance for him/herself (76%)• 24% were others consulting about a

student

Typical On-Call Consultee

Typical POC was a Caucasian, heterosexual, undergraduate (male

or female) who reported high level of general distress and was already a

client at the counseling center

On-Call POC: Demographics

(n =41)

Gender

%

Male 51%

Female 49%

Academic Status

%

Undergraduate

67%

Graduate 25%

Race/Ethnicity

%

Caucasian 68%

Asian 15%

Black 5%

Hispanic 5%

Other 3%

Sexual Orientatio

n

%

Heterosexual

71%

LGBTQ 17%

Unknown 12%

International Students = 19%

85% were current clients

Age

Mean = 23.2

Range = 18-39

On-Call Consultees: Description

Self

(cal

ler)

Frie

nd/P

artn

er

Stud

ent A

ffairs

No UB

Affilia

tion

UB St

uden

t

Fam

ily0%

10%20%30%40%50%60%70%80%90%

100%

On-Call Consultations: Reasons

Suicidal th

ough

ts

High

gene

ral d

istre

ss

Anxiet

y/Pa

nic

Depre

ssive

sym

ptom

s

Relat

iona

l pro

blem

s

Med

ical/M

edicat

ion

issue

Trau

ma/

Loss

Psyc

hotic

sym

ptom

s

Conce

rn fo

r som

eone

Acad

emic d

istre

ss0%

10%

20%

30%

40%

50%

On-Call: Interventions• Coaching (95%)

• Contracting for safety• Short-term coping skills or problem-solving• How to talk to someone you are concerned about

• Referred to Counseling Services (93%)• Sent for hospital evaluation (7%)• Referred to community services (2%)• Other points of contact

• 27% Students of Concern• 44% External Consultations

On-Call: Case Examples

• “My father is annoying me by calling all the time”

• “Holding on to distress all weekend”

Students of Concern Committee

• Representatives: University Police, Judicial Affairs, Residence Life, Health Services, Counseling Services, others as needed

• Meets weekly• Hospital transports for alcohol or

mental health• Role of Counseling Services Rep

SOC Referral Source, Contact & Transports (n = 136)

Discussed at SOC %

Discussed once 55%

Discussed > once 44%

> 1 distinct incident 7%

Referral Source

%

Campus Police 44%

Faculty/Staff 42%

Student 5%

Family 4%

Student Affairs 4%

No affiliation 2%

Alcohol or Mental Health Hospital Transport

20%

Typical Student of Concern

The typical SOC is a Caucasian, undergraduate, male who is not a client at the counseling center. He was referred to the committee by

campus police or faculty/staff because of concern about his suicidal thoughts or behavior.

Students of Concern: Demographics

Age

Minimum = 18

Maximum = 29

Mean = 23.2

Race/Ethnicity

%

Caucasian 54%

Asian 27%

Black 12%

Other 5%

Hispanic 2%

International Students = 19%

Gender %

Male 57%

Female 43%

Client Status %

Non-client 60%

Current client 27%

Former client 13%

Reason for SOC Referral:

Suicidal id

eatio

n

Vict

im o

f crim

e

Psyc

hotic

sym

ptom

s

Disrup

tive

beha

vior

Perp

etra

tor o

f crim

e

Conce

rn fo

r som

eone

Med

ical/M

edicat

ion

issue

Perp

etra

tor o

f har

assm

ent

Additio

n/Su

bsta

nce

use

0%

10%

20%

30%

40%

50%

Students of Concern: Interventions*

• Student support coordinator 66%• Counselor notified 38%• Referred to counseling 17%• Judicial hearing 14%• Police follow-up 13%• Counseling Services outreach 8%• Mandated evaluation 6%• Referred off-campus 3%• Referred to Health Services 2%

Students of Concern: Case Example

“Victim of Home Invasion“

“Significant Disruption in the Apartments”

External Consultations: Overview

• Emails, calls, or in-person consultations with counseling staff during business hours

• 283 unique cases; 553 total consultations

• 36% had multiple consultations• Only 1 student consulted about

him/herself• 24% were discussed at SOC meeting• 5% had at least one On-Call Contact

External Consultation: Demographics

Gender %

Female 56%

Male 46%

Transgender

1%Age

Minimum = 17

Maximum = 49

Mean = 23.4

Race/Ethnicity

%

Caucasian 63%

Asian 19%

Black 7%

Unknown 6%

Hispanic 2%

Multiracial 2%

Academic Status

%

Undergraduate 68%

Graduate 27%

Non-matriculating

5%Client Status %

Non-client 29%

Current client 54%

Previous client 17%International Students =

18%

External Consultees: Description

Facu

lty/S

taff

Off-Cam

pus pr

ovider

Fam

ily m

embe

r

Campu

s Po

lice

Stud

ent A

ffairs

No UB

affilia

tion

Health

Ser

vice

s staff

Stud

ent*

0%10%20%30%40%50%60%70%80%90%

100%

External Consultations: Reasons

Off-ca

mpu

s tre

atm

ent

Poss

ible suicida

l stu

dent

Acad

emic d

ept.

lette

rs

Med

ical/M

edicat

ion

issue

Disrup

tive

beha

vior

Acad

emic p

roblem

s0%

10%

20%

30%

40%

50%

External Consultations: Interventions

• Referred to Counseling Services70%

• Coaching 24%

• Related to hospital evaluation10%

• Referred off campus 9%• Police assistance requested

4%

External Consultations: Case Examples

• “She was behaving very erratically”

• “My son has a history of anxiety and depression”

A Special Case: No-Name Consultations

• Note used when POC was not a student OR when student name was not shared

• 59 No-Name notes for 55 people

No-Name Consultations: Demographics

Gender %

Female 47%

Male 40%

Unknown

13%

Consultee Status %

No UB Affiliation 43%

Faculty/Staff 20%

Family 15%

Student 7%

Non-UB Friends/Partners

2%

POC Status %

No UB Affiliation 47%

UB Student 42%

UB Faculty/Staff 7%

POC: Description

%

Another Person 75%

Self 24%

No-Name Consultations: Reasons

Addictions/Substance

Use

Eating Disorders

Relational Problem

Unknown Need UB Info

Learning Disability

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

No-Name Consultations: Interventions

• 62% of consultees referred to off-campus providers

• 18% of SOCs referred to Counseling Services 

• Only 9% of consultees were coached

Summary Thoughts on Data

• The following varied based on type of consultation:• POC status• Consultee status• Problem type• Intervention implemented

• Consultation is:• time-consuming

• Total of 916 consultation contacts• Requires case management tasks• Requires thorough documentation• Augments AND takes time from direct clinical services

• A pathway to counseling• An Environmental Management Approach

Recommendations for Effective Consultations: Consultees

• Provide a student name & ID# or D.O.B

• Be willing to be a part of the solution & the plan

• Seek to understand limitations of the consultation

Recommendations for Effective Consultations: Consultants

• Benefits/necessity of having student names

• Ask for a call-back number or e-mail• Follow up with an e-mail• Be firm, direct, & honest. • Discuss why confidentiality is not always

possible• Do risk assessment• Validate consultee’s feelings & fears

Recommendations for Consultants Cont’d

• Assume the role of coach • Be “the Calm in the Storm” – debrief

later• Provide developmental context• Discuss limit setting & self care• Have policies that support consultation• Have strong partnerships • Provide education to stakeholders PRIOR

to a mental health emergency

• Staff training in consultation & crisis intervention

• TRUST that counselors want to minimize risk to individuals AND the campus community

Recommendations for Consultants Cont’d

Questions & Discussion