Supporting an International Student Through a Mental Health Crisis

Supporting an International Student Through a Mental Health Crisis NAFSA: Association of International Educators 2012 Annual Conference

Houston, Texas May 30, 2012

PRESENTERS Elaine del Rossi, HTH Worldwide Insurance [email protected]

Trisha Marrapese, University of Texas-Austin [email protected]

Chair: Patricia Burak, Syracuse University [email protected]

Stats on Mental Illness and College Students One out of every five young people and one out of every four college students or adults suffers from some form of diagnosable mental illness. Nearly 50% of all college students report feeling so depressed that they have had trouble functioning, and 15% meet the criteria for depression

Suicide is the third leading cause of death among people ages 15-24, and the second leading cause of death in college students ages 20-24

Over 66 percent of young people with a substance use disorder have a co-occurring mental health problem. About 19 percent of young people contemplate or attempt suicide each year

Four out of every five young people that contemplate or attempt suicide exhibit clear warning signs. An estimated 5 million young females suffer from eating disorders each year, and eating disorders are the deadliest mental illness, claiming more lives than any other illness.

CASE STUDY I A young international Ph.D. student has attempted suicide. He continues to profess suicidal thoughts, and seeks assistance with the Counseling Center. At the same time, other actions result in the student’s expulsion from campus. He is committed to a mental health facility.

Things to Consider…. Does the student have insurance? If so, does he have proof of insurance in his possession?

Has anyone been contacted on the student’s behalf? Who are the student’s emergency contacts and do they speak English?

What is the state of the student’s current physical and mental health? How does FERPA come into play

What are the immigration consequences related to the student’s expulsion? What are the possible treatment options for the student once they depart the U.S.? (is there social stigma to account for)

The Facts of the Case The student has health insurance coverage, including medical evacuation and repatriation The student’s family is from Indonesia and does not speak English (nor has he given permission to contact them)

In the Hospital The student is placed in a ward with an empty bed, which happened to be far away from campus, but close to where someone from your office happened to be visiting on the night of the incident (the very person who was notified of the recent chain of events by university police)

So….What You Do Now?

The individual who was contacted from the University went to visit the student in the facility The student appeared to be of sound mind at this time. The actions that had warranted his expulsion had not been criminal in nature, and the student pleaded with the University official to sign him out of the Mental Health facility….which he did.

Little Did He Know… Unfortunately, upon signing the student out of the institution, the University had nullified any possibility for Medical Evacuation insurance to be utilized (for which he would have been eligible, due to his current condition)

As the student was expelled, and no longer able to remain in the US in F-1 status, the University had assumed responsibility (and expense) for the student’s safe return home.

The Student Now Needs to Return to Indonesia…. …and guess who was chosen to accompany him?

Things to Consider When Planning an Impromptu Trip to Indonesia…(or anywhere)

• Flight logistics and cost on two-days notice • Visas….do you need one for your destination country? How about the countries you will hit in transit? • The purchase of your own insurance for the trip • How to safely communicate the student’s situation with their family back home

East Coast U.S. to Indonesia

Is the student’s passport valid? The purchase of your own insurance for the trip How to safely communicate the student’s situation with their family back home

Things Even The Most Seasoned Traveler Can’t Plan For: Lack of sleep: Total travel time was 27 hours

Erratic behavior: The student tried to open the emergency exit on the airplane, mid flight

Weather conditions: We made an unplanned landing in Taiwan because a minor Tsunami had struck Jakarta, Indonesia, so we were unable to land

All’s Well That Ends Well • The student was successfully returned to his father’s care in Indonesia (despite a misunderstanding at the airport over my use of the word “escort”) • The student was able to seek the counseling that he needed (with the support of his family, despite the social stigma and the financial hardship), which enabled him to apply for readmission to the university two years later

How could this have played out differently if the student had been able to utilize his medical evacuation insurance?

The “Cup Half Full” Outcome: Greater collaboration with other offices on campus (Counseling Center, Dean of Students Office, International Office, etc…) in the creation of a “Mental Health Crisis Response Checklist” A better understanding of the benefits offered by most health insurance providers, including but not limited to protocol on medical evacuation, availability of translators, and other such immensely valuable resources

Checklist for Mental Health Issues

CASE STUDY II You receive a phone call from a concerned parent who has been unable to reach his daughter for the past four days. As this is not typical behavior, he is very concerned.

Your phone calls to the residence hall and academic department confirm that she has not been on campus for the past four days

• Whom else do you contact? • Is there a Crisis Team/protocol that needs to be followed?

The father has made contact with the president of the national group. A graduate student, he has found out from friends that the student was taken to the hospital

You contact the hospital and identify yourself as the international student advisorthey are willing to give you information regarding the student Now what do you do?

Guidelines for Visiting Psychiatric Unit • Cannot bring anything glass (ie Flower Vase) • Patient cannot have a computer, cellphone, pens or pencils (only crayons) • HIPAA Release needed for insurance company to begin a claim (very important for future medical evacuation)

Health Insurance: What you need to know to help HIPAA requirements: what is needed?

Medical evacuation: how does it work? – Escort to home country – Family member travelling to USA

Repatriation

FERPA HIPAA Family

FERPA Release Syracuse University

Permission to Release Education Record Information as Required by the Family Educational Rights and Privacy Act (FERPA)

I, , give permission for Syracuse University (David B. Falk College of Sport and Human Dynamics) to release academic and graduate assistantship performance evaluation information to Patricia A. Burak. Purpose for release: Review of dismissal from Doctoral Program. Information to be released: Grades, faculty evaluations, Oral exam evaluations.

Signed:_______________________________ Date:___________________

HIPAA Release HIPAA Privacy Authorization Form **Authorization for Use or Disclosure of Protected Health Information (Required by the Health Insurance Portability and Accountability Act, 45 C.F.R. Parts 160 and 164)**

I, Patient’s name, authorize Name of Facility/Physician to use and disclose the protected health information described below to HTH Worldwide and/or its representatives including Name of University if applicable. This authorization for release of information covers the period of healthcare from: 3 Month time span. I authorize the release of my complete health record (including records relating to mental healthcare communicable diseases, HIV or AIDS, and treatment of alcohol or drug abuse). This medical information may be used by the organization I authorize to receive this information for medical treatment or consultation, billing or claims payment, or other purposes as I may direct. This authorization shall be in force and effect until Date from Above, at which time this authorization expires. I understand that I have the right to revoke this authorization, in writing, at any time. I understand that a revocation is not effective to the extent that any person or entity has already acted in reliance on my authorization or if my authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim. I understand that my treatment, payment, enrollment, or eligibility for benefits will not be conditioned on whether I sign this authorization. I understand that information used or disclosed pursuant to this authorization may be disclosed by the recipient and may no longer be protected by federal or state law.

Signature of patient or personal representative:

________________________________________

Patient’s Name Date: ___________________________________

Supporting the Student • Academic Notifications • Health Center Notifications • Residence Hall Notifications *Consent of the student is required

Friends Favorite Foods Clothing

Books

Preparing for Hospital Release • Return to Home Country • Return to Campus • Return to Residence Hall

Medical Evacuation • Medical Escort • Airfare/Passport/Visa? • Leave of Absence

SEVIS Actions • RCL for Medical Reasons • Leave of Absence • Discontinue Program

Social Stigmas • Cultural Taboos Surround Mental Health • Shame in Front of Peers • Denial

Comprehensive Resource on Crisis Management for the International Student and Scholar Services Office • NAFSA Website

Crisis Management in a Cross-Cultural Setting

Sample Institutional Letters Mandated Contact Attachment 1—Mandated Contact VIA PERSONAL DELIVERY Student’s Name Address Dear [Student’s Name]: This letter is written on behalf of Senior Vice President and Dean of Student Affairs XXX to follow up on [state the factual circumstances that brought student within the scope of the Protocol for Responding to Student Mental Health Incidents]. We are concerned about your well-being, and we would like to make your continued stay at XXX University as smooth as possible. To promote your access to appropriate resources, you are required to meet with a Counseling Center therapist to discuss this incident and develop a plan for maintaining safety and promoting your overall well-being. This policy of referring students to the Counseling Center is designed to assist students who have demonstrated that they are experiencing difficulty in managing some aspects of University life. Please contact the Counseling Center at XXX-XXXX, to schedule this appointment. During this meeting you will be requested to sign a release of information allowing the Counseling Center staff to confirm your participation in this meeting to [the administrator designated to act on behalf of the Senior Vice President and Dean of Student Affairs]. Provided that you participate in this meeting and allow the Counseling Center to confirm your participation, we anticipate that you will be permitted to continue as a [residential student, student] of XXX University. All information you share during this meeting will be held confidential by the Counseling Center. We are aware that you may feel anxious in anticipation of this meeting. If you need to talk to someone before the meeting occurs, feel free to contact the Office of student Assistance at XXX-XXXX or the Counseling Center at XXX-XXXX. Sincerely,

Designated Administrator Name and Title cc:

Senior Vice President and Dean of Student Affairs Counseling Center Office of Student Assistance File

Sample Institutional Letters Mandated Assessment

Attachment 2—Mandated Assessment VIA PERSONAL DELIVERY Student’s Name Address Dear [Student’s Name]:

This letter is written on behalf of Senior Vice President and Dean of Student Affairs XXX to follow up on [state the factual circumstances that brought student within the scope of the Protocol for Responding to Student Mental Health Incidents]. We are concerned about your well-being. To promote your access to appropriate resources, you are required to meet with a Counseling Center therapist to discuss this incident and develop a course of treatment, and/or a personal safety plan that may help enhance your overall health and wellness in the future. This policy of referring students to the Counseling Center is designed to assist students who have demonstrated that they are experiencing difficulty in managing some aspects of University life. Due to the serious nature of the incident in which you were involved, you are not permitted to attend classes, live in or visit the residence halls or South Campus, live in or visit the Greek chapter houses, or enter onto University owned, operated, or controlled property, except with the permission of the Senior Vice President and Dean of Student Affairs or his or her designee until this matter is resolved. In order to begin this process, please contact The Counseling Center at XXX-XXXX. We will arrange for you to meet with a staff member in the Office of Student Assistance, at 306 XXX Hall to discuss this process in detail and to answer any questions you may have. Following your appointment with Student Assistance, you will meet with a staff therapist, at XXX Street Place. During this meeting you will be requested to sign a release of information allowing the Counseling Center staff to obtain information from your personal physician(s) and/or therapist(s) and to share its recommendations with the Office of the Senior Vice President and Dean of Student Affairs. These recommendations will be considered in making a final determination concerning your status as a student at XXX University. You will be invited to participate in this process. We are aware that you may feel anxious in anticipation of this meeting with the Counseling Center. If you need to talk to someone before the meeting occurs, feel free to contact the Office of Student Assistance at XXX-XXXX or the Counseling Center at XXX-XXXX. Sincerely, Designated Administrator Name and Title cc:

Senior Vice President and Dean of Student Affairs Counseling Center Office of Student Assistance [Parents or Guardians—where appropriate] File

Sample Institutional Letters Follow up to Mandated Contact Attachment 3 – Follow up to Mandated Contact

DATE

Name Address Dear [Name]: This letter is written to follow up on your recent meeting with the Counseling Center on [date] held to discuss an incident that occurred on [date] in which you [state facts that supported the mandated referral to the Counseling Center]. The Counseling Center confirms that you have successfully met the requirements of my letter dated [date] mandating your attendance at this meeting. We hope that this meeting was helpful to you and that you follow any recommendations offered by the Counseling Center. If at any point you need additional assistance, please contact the Counseling Center (24 hours a day) at XXX-XXXX or the Office of Student Assistance at XXXXXXX. Sincerely,

Name Title cc:

Senior Vice President or Dean of Student Affairs Counseling Center Office of Student Assistance File

Resource Bibliography • International Student Resources bibliography.docx

Don’t we wish that this was “THE END”? Such cases will continue as long as we have students….. Being prepared to work through a mental health situation is your best solution. This powerpoint is posted at http://international.syr.edu/ be used with the permission of the presenters.