working with student with mental health issues--delusions of persecution
February 25, 2016 8:44 PM
I have an adult ed student who has been quite distressed lately. He likes me and will often share things about his life. Recently he has seemed both physically and mentally unwell, and today he told me he thinks one of his neighbours (whom he doesn't like AT ALL, and is not shy about saying so) is making him sick via invisible rays. Specifically, my student believes this neighbour is sending rays from their television and radio that are causing him to have headaches and blurred vision. Have you ever worked with a student who had delusions like this? How did you handle it? What is the best thing I can do, as a non-mental health professional who interacts with this student daily?
FWIW he has never struck me as a danger to himself or others, but he seems increasingly distressed and I am worried about his well-being. I'm not sure if my approach today (sympathizing with the distress, not arguing with him about the validity of his odd ideas, and encouraging him to see his doctor) was the right one. He he told me he's talked to his doctor but the doctor does not know how to help. It was unclear whether he had told the doctor about his invisible TV and radio rays theory, and I didn't press further.
I have already notified the student mental health support people via e-mail (wasn't able to connect with anyone in person or over the phone). I'm waiting to hear back from them, but I know I won't hear anything before I meet with this student again tomorrow. Due to severe cutbacks, the mental health workers we have for students are extremely overstretched and their caseloads are enormous, so cases that aren't urgent tend to go to the bottom of the pile. The problem is, I can't tell if this case is urgent. I mean, I know it's not a great sign when people have delusions they're being persecuted, but I'm not a mental health professional, so it could just seem more alarming to me than it really is.
How worried should I be? Is there anything else I should be doing?
FWIW he has never struck me as a danger to himself or others, but he seems increasingly distressed and I am worried about his well-being. I'm not sure if my approach today (sympathizing with the distress, not arguing with him about the validity of his odd ideas, and encouraging him to see his doctor) was the right one. He he told me he's talked to his doctor but the doctor does not know how to help. It was unclear whether he had told the doctor about his invisible TV and radio rays theory, and I didn't press further.
I have already notified the student mental health support people via e-mail (wasn't able to connect with anyone in person or over the phone). I'm waiting to hear back from them, but I know I won't hear anything before I meet with this student again tomorrow. Due to severe cutbacks, the mental health workers we have for students are extremely overstretched and their caseloads are enormous, so cases that aren't urgent tend to go to the bottom of the pile. The problem is, I can't tell if this case is urgent. I mean, I know it's not a great sign when people have delusions they're being persecuted, but I'm not a mental health professional, so it could just seem more alarming to me than it really is.
How worried should I be? Is there anything else I should be doing?
Your employee manual should have a CLEAR policy for this, and if not, you should seek instruction from your supervisor. You have only downside in improvising. (Policies for mentally ill people who are visibly decompensating will range from "do absolutely nothing" to "call 911" -- there is no way to guess what your policy is.)
posted by MattD at 9:01 PM on February 25, 2016
posted by MattD at 9:01 PM on February 25, 2016
Rays or no rays, the headaches and blurred vision should, I think, merit immediate attention. I'm not a medical professional, just encouraging you to emphasize the more physical symptoms when talking about this both to your student and to others; they seem significant, as in potential tumor or something significant (however the problem is caused - by the roommate or otherwise).
Perhaps you could persuade him to seek treatment for these symptoms - even excusing him from class if he's got a super bad headache and/or is unable to see all the way to the front of the class -- and then maybe mention the possible source of the trouble to whatever medical professional -- neurologist? -- can see him.
posted by amtho at 9:19 PM on February 25, 2016
Perhaps you could persuade him to seek treatment for these symptoms - even excusing him from class if he's got a super bad headache and/or is unable to see all the way to the front of the class -- and then maybe mention the possible source of the trouble to whatever medical professional -- neurologist? -- can see him.
posted by amtho at 9:19 PM on February 25, 2016
How old is he? Peak age for schizophrenia onset in men is early twenties. Other possibilities include depression with psychotic features, psychotic symptoms in a manic episode, and brain cancer. All pretty serious. Definitely try to continue appearing sympathetic while encouraging him to get medical attention. Can you literally walk him over to the school clinic after class one day when he's complaining of headache or blurred vision? ("Come on, it's on my way, I'll just feel better if I know someone's helping you.") I know that's a big commitment and gets you personally involved in a way you may not be comfortable with (especially if you're a woman), but these kinds of beliefs are a symptom of real illness. This guy needs help.
posted by praemunire at 9:35 PM on February 25, 2016
posted by praemunire at 9:35 PM on February 25, 2016
MexicanYenta, thank you for letting me know that I did what one is supposed to do. I am relieved to hear it. It seemed the right thing to do, but I haven't had much guidance. Which leads me to...
MattD, there is no clear policy on what we should do. We have a short faculty info page on dealing with students in distress: first, faculty should use their judgment to evaluate if the student is a threat to themselves or others. (Remember, I am not a mental health professional so I don't necessarily trust my judgment on that. But let's just go with it.) If yes, call security/911/the counsellor or doctor if s/he's around. If the student isn't a threat to themselves or others, we are supposed to ask colleagues/supervisors for ideas about what to do. But they're not MH professionals either, and so they don't know what to do any more than I do! Anyway, this doesn't invalidate what you said at all; I just want to explain the rather frustrating context I'm working in.
amtho--I agree he will probably be more receptive to being encouraged to get a second opinion about the headaches/blurred vision. That's a good tack for me to take.
praemunire--he is about 40. I know he has some kind of connection with the local brain injury group, but I don't know any other specifics. From some things he's told me, I suspect he's received in-patient treatment for psychiatric issues, but I don't know what.
I didn't mention this in my post because it was already so long, but today during class I actually did walk him down to the school clinic so he could get his eyes checked out, since he was obviously in physical distress. It's fairly common for faculty to do this in my program. This is when he told me about his TV ray theory. That galvanized me even more to get him seen by someone, but when we got there the clinic was closed--it is apparently closed daily at exactly the time he is in class with me every day. Sigh. I guess I could offer to take him at the end of class, when it opens, and maybe make an appointment for him ahead of time, so they can see him right away as a "drop-in." He's usually pretty reluctant to get help, so I was surprised today when he agreed to go with me. And then...there was no one to see him.
This next part is basically me venting, but: it's hard to really convey exactly how devastating the cuts to our mental health services have been. That has meant not only a lack of people to help our students, but also a lack of resources for faculty to ask how we should handle these things. When these things used to happen, I'd go to one of the counsellors and ask for advice. Now the counsellors are not there anymore. The remaining resource people we do have are pretty much 100% tied up putting out fires and dealing with urgent cases. They are nice people but they literally do not have the time to sit with faculty and answer questions about how we should be helping students in our classrooms. We have asked for speakers to come and give us concrete examples of how to deal with specific situations and the one speaker who came just spoke about what it is like to live with a mental illness and how to work to avoid placing stigma on the student. They couldn't answer any of our specific questions about what to do in the classroom! We were all left still not knowing what to DO.
I don't want to overreact but I also don't want to underreact. I know that interactions with the system don't always go well for people with mental illness, and I don't want to make it worse by overreacting, but if it's serious I definitely don't want to underreact.
posted by Secret Sockdentity at 9:53 PM on February 25, 2016
MattD, there is no clear policy on what we should do. We have a short faculty info page on dealing with students in distress: first, faculty should use their judgment to evaluate if the student is a threat to themselves or others. (Remember, I am not a mental health professional so I don't necessarily trust my judgment on that. But let's just go with it.) If yes, call security/911/the counsellor or doctor if s/he's around. If the student isn't a threat to themselves or others, we are supposed to ask colleagues/supervisors for ideas about what to do. But they're not MH professionals either, and so they don't know what to do any more than I do! Anyway, this doesn't invalidate what you said at all; I just want to explain the rather frustrating context I'm working in.
amtho--I agree he will probably be more receptive to being encouraged to get a second opinion about the headaches/blurred vision. That's a good tack for me to take.
praemunire--he is about 40. I know he has some kind of connection with the local brain injury group, but I don't know any other specifics. From some things he's told me, I suspect he's received in-patient treatment for psychiatric issues, but I don't know what.
I didn't mention this in my post because it was already so long, but today during class I actually did walk him down to the school clinic so he could get his eyes checked out, since he was obviously in physical distress. It's fairly common for faculty to do this in my program. This is when he told me about his TV ray theory. That galvanized me even more to get him seen by someone, but when we got there the clinic was closed--it is apparently closed daily at exactly the time he is in class with me every day. Sigh. I guess I could offer to take him at the end of class, when it opens, and maybe make an appointment for him ahead of time, so they can see him right away as a "drop-in." He's usually pretty reluctant to get help, so I was surprised today when he agreed to go with me. And then...there was no one to see him.
This next part is basically me venting, but: it's hard to really convey exactly how devastating the cuts to our mental health services have been. That has meant not only a lack of people to help our students, but also a lack of resources for faculty to ask how we should handle these things. When these things used to happen, I'd go to one of the counsellors and ask for advice. Now the counsellors are not there anymore. The remaining resource people we do have are pretty much 100% tied up putting out fires and dealing with urgent cases. They are nice people but they literally do not have the time to sit with faculty and answer questions about how we should be helping students in our classrooms. We have asked for speakers to come and give us concrete examples of how to deal with specific situations and the one speaker who came just spoke about what it is like to live with a mental illness and how to work to avoid placing stigma on the student. They couldn't answer any of our specific questions about what to do in the classroom! We were all left still not knowing what to DO.
I don't want to overreact but I also don't want to underreact. I know that interactions with the system don't always go well for people with mental illness, and I don't want to make it worse by overreacting, but if it's serious I definitely don't want to underreact.
posted by Secret Sockdentity at 9:53 PM on February 25, 2016
It's a most justified vent. For a sick person, there is something uniquely terrifying and humiliating about asking for help and being shut out. The sense of abandonment can be overwhelming. So if you feel comfortable taking him after class, it would be a very kind act.
Your concerns about whether mentally ill people benefit in general from interacting with the health-care system are also well founded, but for someone potentially slipping into psychosis, the risks are probably worth taking.
posted by praemunire at 10:05 PM on February 25, 2016
Your concerns about whether mentally ill people benefit in general from interacting with the health-care system are also well founded, but for someone potentially slipping into psychosis, the risks are probably worth taking.
posted by praemunire at 10:05 PM on February 25, 2016
What country are you located in?
posted by pintapicasso at 1:53 AM on February 26, 2016
posted by pintapicasso at 1:53 AM on February 26, 2016
It's impossible to say exactly what's going on over the internet--it could be something like paranoid schizophrenia, drug toxicity, head trauma, etc., but I would agree that it is very concerning and could persist or show decompensating signs quickly. I would recommend calling the mental health team at your school again, and if they don't respond quickly, to call a mental health crisis line, or even ER, in your local area. They will be most familiar with protocols and resources for your area. In general, you can't force someone into treatment unless they pose a grave danger to self or others, but it is worth investigating and flagging with the local, most responsible authorities. I'd also recommend that you should document all calls and attempts at communication that you have.
It sucks that you have to deal with this on your own, but it's great that you're aware and compassionate enough to try to help.
posted by stillmoving at 2:16 AM on February 26, 2016
It sucks that you have to deal with this on your own, but it's great that you're aware and compassionate enough to try to help.
posted by stillmoving at 2:16 AM on February 26, 2016
I knew someone who started having paranoid delusions out of nowhere and it turned out to be a case of slow carbon monoxide poisoning. You can get a combined smoke-and-CO detector for $24 at Home Depot. Do you think your student would have the funds to buy such a thing? If so, could you encourage him to buy one?
Other possible signs of carbon monoxide poisoning are:
Dull headache
Weakness
Dizziness
Nausea or vomiting
Shortness of breath
Confusion
Blurred vision
Loss of consciousness
posted by colfax at 4:24 AM on February 26, 2016
Other possible signs of carbon monoxide poisoning are:
Dull headache
Weakness
Dizziness
Nausea or vomiting
Shortness of breath
Confusion
Blurred vision
Loss of consciousness
posted by colfax at 4:24 AM on February 26, 2016
It might be helpful to look at some guidelines from other universities as far as how they expect faculty to respond. UCSC's guidelines look helpful, and Wellesley has another good document (pdf).
I know in a similar situation I have never felt quite so helpless as I did in the face of a giant university of bureaucracy with nobody willing or able to reach out to help my student - not even the people explicitly trained to do so! Good luck!
posted by ChuraChura at 5:24 AM on February 26, 2016
I know in a similar situation I have never felt quite so helpless as I did in the face of a giant university of bureaucracy with nobody willing or able to reach out to help my student - not even the people explicitly trained to do so! Good luck!
posted by ChuraChura at 5:24 AM on February 26, 2016
if it's serious I definitely don't want to underreact.
It could be? The big thing is basically determining if there's an underlying organic cause (i.e. carbon monoxide, meds that are off, high stress, lack of sleep etc) and if not, making sure he gets the appropriate mental health treatment. As others have said, you're totally doing the right stuff. My partner has a son who is psychotic (but not floridly psychotic) as a result of schizo-affective disorder a lot of the time and the issues we watch out for are not so much if he's hearing voices or making odd connections between things (which he often is) but whether those things are distressing him. To someone who has interacted with a lot of people with mental illness, this "Neighbor hassling me with rays from the TV" is a weirdly "normal" delusion even though it can sound really bizarre to someone who may not have heard it much before.
I think if it were me, I'd make sure student mental health services understood that the headaches/vision issues were, according to the student, being "caused" by extraordinary things and then let them take it from there. I know it's difficult to draw decent boundaries but it might be worth asking about other people in his support network who might be able to help with this who may be more used to this situation and know what to do specifically.
posted by jessamyn at 6:00 AM on February 26, 2016
It could be? The big thing is basically determining if there's an underlying organic cause (i.e. carbon monoxide, meds that are off, high stress, lack of sleep etc) and if not, making sure he gets the appropriate mental health treatment. As others have said, you're totally doing the right stuff. My partner has a son who is psychotic (but not floridly psychotic) as a result of schizo-affective disorder a lot of the time and the issues we watch out for are not so much if he's hearing voices or making odd connections between things (which he often is) but whether those things are distressing him. To someone who has interacted with a lot of people with mental illness, this "Neighbor hassling me with rays from the TV" is a weirdly "normal" delusion even though it can sound really bizarre to someone who may not have heard it much before.
I think if it were me, I'd make sure student mental health services understood that the headaches/vision issues were, according to the student, being "caused" by extraordinary things and then let them take it from there. I know it's difficult to draw decent boundaries but it might be worth asking about other people in his support network who might be able to help with this who may be more used to this situation and know what to do specifically.
posted by jessamyn at 6:00 AM on February 26, 2016
If it were me, I'd err on the side of overreacting. However, it wouldn't be my job on the line, probably.
posted by amtho at 6:23 AM on February 26, 2016
posted by amtho at 6:23 AM on February 26, 2016
Any time someone without a history of hallucinations starts having them it is urgent. Many people with illnesses that cause them to hallucinate have lots of time history about how they've reacted in the past to these things, but if it is new he needs to be assessed as soon as possible.
At 40 that would be a really late onset for schizophrenia. His
Brain injury group proboblyv had soon good baseline reports which may help get him the right services.
posted by AlexiaSky at 8:30 AM on February 26, 2016
At 40 that would be a really late onset for schizophrenia. His
Brain injury group proboblyv had soon good baseline reports which may help get him the right services.
posted by AlexiaSky at 8:30 AM on February 26, 2016
Do you have any way to contact spouse (if any) or parents?
I once had a co-worker who was literally working in a tin foil hat and tin foil-lined pants. (OK, aluminum foil.) Eventually, he had to be let go, and I know the boss called his wife.
posted by SemiSalt at 9:24 AM on February 26, 2016
I once had a co-worker who was literally working in a tin foil hat and tin foil-lined pants. (OK, aluminum foil.) Eventually, he had to be let go, and I know the boss called his wife.
posted by SemiSalt at 9:24 AM on February 26, 2016
Can you try the Ombuds office? This may not technically be their wheel house and usually they're geared towards helping students directly, but they may be able to direct you to some other resources: the Ombuds office at my university has been working to provide better access to policy information on all sorts of matters after they realized that there were policies that weren't published, or had been updated but the older versions were still floating around. I believe all contact is supposed to be confidential as well.
posted by ghost phoneme at 9:39 AM on February 26, 2016
posted by ghost phoneme at 9:39 AM on February 26, 2016
headaches and blurred vision
These can be symptoms of medical problems for sure.
I actually did walk him down to the school clinic so he could get his eyes checked out
He doesn't need to get his eyes checked out, he needs to see a doctor who can rule out other medical causes of these symptoms. Some of the possible causes have nothing to do with the eyes (This is something I wish I'd known, sooner). It sounds like there has been a sudden onset of these symptoms and he should tell the doctor that. After that, if he needs glasses, people sometimes get mild headaches from having uncorrected vision. But an optometrist is not where to start.
I know that you can't really do much, but if you are encouraging him to seek help, encourage him to start with an MD.
posted by yohko at 10:54 AM on February 26, 2016
These can be symptoms of medical problems for sure.
I actually did walk him down to the school clinic so he could get his eyes checked out
He doesn't need to get his eyes checked out, he needs to see a doctor who can rule out other medical causes of these symptoms. Some of the possible causes have nothing to do with the eyes (This is something I wish I'd known, sooner). It sounds like there has been a sudden onset of these symptoms and he should tell the doctor that. After that, if he needs glasses, people sometimes get mild headaches from having uncorrected vision. But an optometrist is not where to start.
I know that you can't really do much, but if you are encouraging him to seek help, encourage him to start with an MD.
posted by yohko at 10:54 AM on February 26, 2016
Thank you everyone. This has been very reassuring and helpful. I'm convinced this is serious and urgent enough for me to keep pushing until someone with professional knowledge takes it seriously.
To answer some questions/comments above:
posted by Secret Sockdentity at 10:57 AM on February 26, 2016
To answer some questions/comments above:
- We are in Canada.
- I'm not worried about losing my job--my faculty union is quite strong. I'm more concerned about maintaining personal and professional boundaries for myself, while still advocating for my student and helping him navigate the system.
- I'm concerned about maintaining my student's privacy and autonomy...but also about not letting him slip into a dangerous situation.
- Student is not married. Parents are in town, but I'm not allowed to contact them without the student's permission, because of privacy laws. That much I know.
- The only reason I know about the affiliation with the brain injury group is because another student who belongs to the group accidentally revealed it in class. My student has never mentioned it to me directly and I've never brought it up with him. I pretended I hadn't overheard the other student.
- He did tell me about an extended hospital stay--I inferred it was in the psych unit because a friend had had a similar experience to what he described. My student never came out and said it, and is very defensive when issues of mental illness come up in class, so I know I'll have to be careful in order not to break trust with him.
posted by Secret Sockdentity at 10:57 AM on February 26, 2016
[This is an answer from an anonymous commenter.]
my student believes this neighbour is sending rays from their television and radio that are causing him to have headaches and blurred vision.posted by cortex at 11:49 AM on February 26, 2016
Do not "encourage him to get a second opinion" about the headaches and blurred vision. That dismisses his theory of what caused it. Do encourage him to get medical treatment for it.
Some parts of this you can engage as a meaningful attempt to communicate about real problems:
A) I have headaches and blurred vision.
B) I do not trust my neighbor and I think they are harming me in ways I cannot actually prove.
C) I really want you to help me in some meaningful way. You, personally, have been less of an asshole to me than most people. Most other people just act like I am making shit up. Please, please do not do that. I actually have some kind of problem and I am incredibly frustrated that everyone tells me it is in my head and makes zero effort to help me solve something that is actually negatively impacting me.
When I was living with relatives during my divorce, my two sons were in their male cousin's bedroom. My father, who had Alzheimer's, burst in and accused my two sons of smoking dope. My father could never remember who my sons were. Their cousin was smoking marijuana and often had a male friend over that he smoked with. So, in spite of the fact that grandpa was accusing the wrong two young men, he was absolutely correct that he had a male grandson who was smoking mj, that this male grandson often did so in the company of another young man and often could be found in the room in question.
People with mental health problems may be unreliable witnesses, but that doesn't mean they are making things up whole cloth. Please try to take seriously that there is a genuine problem behind his complaints and that it isn't just stuff he is making up whole cloth.
Just to clarify: I absolutely believe my student is having headaches and blurred vision. He told me that his doctor couldn't help with the symptoms, so my idea is to suggest he get a second opinion on whether something can be done to relieve the headaches/vision, not imply that the TV rays theory is wrong.
posted by Secret Sockdentity at 12:46 PM on February 26, 2016
posted by Secret Sockdentity at 12:46 PM on February 26, 2016
Okay. I finally managed to connect with two (hellishly overworked) people who could help. The three of us were able to sit down with the student right after my class period (privately, not in front of the other students). I introduced them as school health workers and explained that I had asked them for help after our talk yesterday because I was so worried about his headaches and vision problems. We emphasized that the physical symptoms are serious and warrant having a doctor look at him, and we also apologized that there was no one to see him yesterday.
My fears about him keeping mum about the neighbour and the rays theory were unfounded--the poor guy is so at the end of his rope that he spilled out the whole story to the other two! He is clearly so distressed we all really felt for him! He talked for a really long time. I mean, at great length. But it was fantastic that he was so willing to trust us. I think it helped that I was there as someone he knows and and likes already, but I was so worried he would feel I had broken his trust. He did not react that way at all, and even agreed that I could take him to the school clinic Monday when the physician returns--she will do a full checkup, physical and mental health. Now I feel a little more confident he will start to get the help he needs. He seemed a lot happier after our meeting today.
Thank you all for reassuring me I wasn't overreacting and encouraging me to push to get him seen by someone. I have learned so much from this experience that will be helpful for other students in future. I will also be writing some strongly worded letters to those in charge of staffing budgets for student mental health. On talking to the two staff today I learned the situation is even worse than I feared re: lack of resources. So it's even more important students have advocates for them.
posted by Secret Sockdentity at 8:53 PM on February 26, 2016
My fears about him keeping mum about the neighbour and the rays theory were unfounded--the poor guy is so at the end of his rope that he spilled out the whole story to the other two! He is clearly so distressed we all really felt for him! He talked for a really long time. I mean, at great length. But it was fantastic that he was so willing to trust us. I think it helped that I was there as someone he knows and and likes already, but I was so worried he would feel I had broken his trust. He did not react that way at all, and even agreed that I could take him to the school clinic Monday when the physician returns--she will do a full checkup, physical and mental health. Now I feel a little more confident he will start to get the help he needs. He seemed a lot happier after our meeting today.
Thank you all for reassuring me I wasn't overreacting and encouraging me to push to get him seen by someone. I have learned so much from this experience that will be helpful for other students in future. I will also be writing some strongly worded letters to those in charge of staffing budgets for student mental health. On talking to the two staff today I learned the situation is even worse than I feared re: lack of resources. So it's even more important students have advocates for them.
posted by Secret Sockdentity at 8:53 PM on February 26, 2016
Someone directed me to a useful resource for faculty/staff/anyone, so I thought I'd share here: mental health first aid training. I imagine if I had had this, I would have known what to do right away. I think I will register for a course and see if any of my colleagues want to come with me.
National MHFA website for Canada
US
Australia
England
posted by Secret Sockdentity at 4:12 PM on February 28, 2016
National MHFA website for Canada
US
Australia
England
posted by Secret Sockdentity at 4:12 PM on February 28, 2016
Thank you for the update! You are a fantastic person. Thank you for your compassion.
posted by DeltaForce at 10:04 PM on March 1, 2016
posted by DeltaForce at 10:04 PM on March 1, 2016
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posted by MexicanYenta at 8:58 PM on February 25, 2016