Mental health conditions toolkit

If you become aware that you have a student who has been diagnosed with OCD, either through their PLSP or their own disclosure, you can help to support them in a number of ways.

If they are comfortable with it, allow them to be open about their compulsions. Be patient, tolerant and don’t judge.

In the classroom, you may find the person with OCD asking you for reassurance or help in ‘accommodating’ the OCD and following its demands. Helping someone with their compulsions is not usually helpful in the long term. Every time someone acts on a compulsion (including asking for reassurance) it reinforces the belief that the compulsion is the only way to deal with their anxiety.

Treatment for OCD helps people learn that their anxiety will reduce naturally, even if compulsions are not completed. Try to offer other support instead of helping with a compulsion (MIND 2016b).

People with OCD usually report that their symptoms get worse the more they are criticized or blamed because these emotions generate more anxiety (International OCD Foundation 2017). Think about the way in which you offer feedback on activities or assessments, and its tone, to reduce anxiety.

Change and stress can exacerbate OCD symptoms. Stress can be moderated by managing expectations and helping to plan workloads.

Students may need referral to GP and / or counselling services.

You may be less aware of the physical manifestations of OCD in an online environment, though you may be aware of behaviour indicative of ruminations and checking. Try not to get involved in long discussions over one particular issue or accommodate other OCD demands, such as providing constant reassurance.

You should be conscious of the need to limit stress, change and criticism in order to reduce anxiety. Stress can be exacerbated by the physical separation and lack of face-to-face contact in an online environment, so you should work with the student to ensure they feel adequately supported and clearly understand the requirements of the course at each stage.

Don’t say, ‘don’t worry, sometimes I am OCD too’, and don’t assume it’s all about germs and cleanliness.

Don’t collude with OCD demands - this allows the person with OCD to avoid the feared situation and offers them reassurance, which in the short term lowers their anxiety, but in the long term reinforces the fear.

If the student is experiencing a panic attack, advise them to take long, slow deep breaths and offer them a glass of water or a cuppa.

Take them to a quiet room, advise them to sit down and offer a drink of water or a cuppa.

If the student is having trouble gaining control of their breathing, contact a campus first aider.

Do not rush the student, focus on relevant information, speak clearly and concisely.

If they have just left an exam before the end, advise them to make an appointment to see their PAT as soon as possible and offer to email their PAT advising them of the student’s situation.

Help the student develop an action plan that address their main concerns; breaking the problem into smaller parts so are they are less overwhelming.

Suggest they see their GP who could offer advice or refer on to other healthcare professionals.

Suggest they contact university counselling services.

In an online environment, you may be aware that a student has an anxiety disorder or a panic disorder, but you may not know that a student has experienced a panic attack until after it has taken place, when they may inform you about it.

If a panic attack occurs in an online tutorial situation, advise the student to take long, slow deep breaths and to get help locally. Follow this up with a telephone call to the student.

If a student informs you that they have been suffering from panic attacks, longer term you can work with the student to develop an action plan to deal with this to allow them to complete their academic work.

Empathise with the student, try not to pressure them, and ask them how you can help.

Encourage the student to get further advice from Student Services and/or their GP.

Overwhelming the student with information or complicated discussions.

Arguing with the student’s irrational thoughts e.g. you have nothing to worry about or you marks have been really good so far – don’t worry.

Devaluing the information that has been presented to you e.g. it’s not as bad as you think or don’t worry, you have everything going for you.

Assuming the student will get over it without some form of help.

If you become aware of a student with a phobia which may affect their academic work, try to find out more and understand what their phobia means for them.

Don’t put pressure on them or try to make them face their phobia if they are not ready- for example, don’t pressure someone with a fear of speaking in public into doing a presentation in front of the whole class.

If the student is experiencing a panic attack as a result of a phobia, advise them to take long, slow deep breaths and offer them a glass of water or a cuppa.

Take them to a quiet room, advise them to sit down and offer a drink of water or a cuppa.

If the student is having trouble gaining control of their breathing, contact a campus first aider.

Do not rush the student, focus on relevant information, speak clearly and concisely.

If they have just left an exam before the end, advise them to make an appointment to see their PAT as soon as possible and offer to email their PAT advising them of the student’s situation.

Help the student develop an action plan that address their main concerns; breaking the problem into smaller parts so are they are less overwhelming

Suggest they see their GP who could offer advice or refer on to other healthcare professionals.

Suggest they contact university counselling services.

In an online environment, you may not know of a student’s phobia or anxiety until after a panic attack occurs.

If a panic attack occurs in an online tutorial situation, advise the student to take long, slow deep breaths and to get help locally. Follow this up with a telephone call to the student.

Longer term, work with the student to break the problem down into manageable parts and advise them to get further advice from Student Services or their GP.

Overwhelming the student with information or complicated discussions.

Arguing with the student’s irrational thoughts e.g. you have nothing to worry about or you marks have been really good so far – don’t worry.

Devaluing the information that has been presented to you e.g. it’s not as bad as you think or don’t worry, you have everything going for you.

Assuming the student will get over it without some form of help.

In an online environment, you may be aware that a student has PTSD, but you may not know that a student has experienced a flashback until after it has taken place, when they may inform you about it.

If a flashback occurs in an online tutorial situation, advise the student to take long, slow deep breaths and to get help locally. Follow this up with a telephone call to the student.

If a student informs you that they have been suffering from PTSD, longer term you can work with the student to develop an action plan to deal with this to allow them to complete their academic work.

Empathise with the student, try not to pressure them, and ask them how you can help.

Encourage the student to get further advice from Student Services and/or their GP.

Making assumptions about how they feel – each experience is unique and you can’t understand what it is like if you haven’t experienced it yourself.

Dismissing their experiences by saying "it could have been worse" or questioning why they didn't say or do something differently.

Advice for face-to-face students equally applies to online students.

It is important to remember that the person's beliefs are very real to them so try to focus on how they are feeling rather than talking about what is real or true.

Work with the student to minimise stress.

Feeling connected to other people is an important part of staying well, but can be more difficult online. It can help the student to feel valued, confident and more able to face difficult times, so try to maintain contact and relationships through online tools.

Feeling lonely or isolated could make symptoms worse. Encourage the student to develop relationships with peers and classmates for support.

Do not assume that a diagnosis of schizophrenia means that someone has a 'split personality' - many people wrongly think this.

Try not to challenge the person’s beliefs or delusions. They are very “real” to the person who experiences them, and there’s little point in arguing with them about the delusions or false beliefs.

For online students, you should also:

• Give advance notice of any tasks and ensure instructions are clear;
• In online tutorials, allow the student to answer the questions on which they feel the most confident – try not to single them out to answer ‘on the spot’;
• It may help to allocate students into groups for any group work, rather than allowing them to choose groups themselves;
• Follow-up on absences – if anxiety is becoming an issue, the students may miss online chats to avoid facing the anxiety- which may create more anxiety in the long-run.

Don’t respond to worries by telling the student ‘don’t worry’ or ‘don’t be silly’- the worries and fears are real and serious to them – validate and accept their feelings e.g. “I can see that you’re very worried about this assignment”.

Anxiety, moodiness, irritability, impulsiveness, agitation, memory problems, concentration problems, confusion, disorientation, insomnia.

When a student is aggressive in the classroom, here is what you should do:

• Stay calm and observe – show the class you’re in control and aware of the situation.
• Shield your other students from engaging with the aggressive student.
• Nothing - often, it’s best not to say or do anything—allowing the student time to cool off
• Wait – don’t speak to the aggressive student until he or she is in a calm emotional state
• Hold accountable - after the student returns to a calm frame of mind, which could take a couple of hours, briefly explain how he or she will be held accountable and provide a consequence.
• If the behaviour is physically aggressive, you may need to involve more senior management at your college.

Aggression online is unlikely to take the same form and is more likely to be verbal aggression in emails and online discussions. Some of the same advice still applies:

• Remain calm and don’t reply to an aggressive email with a similar tone. If the aggression is via email, wait to reply until you and the emailer are calm.
• If the behaviour takes place in an online Discussion Board or Collaborate session, you should ‘shield’ your online students from this, potentially by removing aggressive posts from a Discussion Board or stepping in to diffuse any tensions arising.
• You may wish to discuss with colleagues as online communications can often be misconstrued and understood in a different tone from that intended.
• If the behaviour continues, you may wish to speak with Student Services, to consider which of your College and UHI policies may be relevant e.g. non-academic misconduct, disciplinary policy, fitness to study policy, etc.

• Don’t try to pull the student aside or touch them - keep your distance and wait until they calm down.
• Don’t get angry yourself- don’t shout or try to use the power of your authority to stop emotionally charged students.
• Don’t try to talk the student around – leave them alone.

• Outward signs - Shouting, swearing, slamming doors, hitting or throwing things and being physically violent or verbally abusive, threatening towards others.
• Inwards signs – telling yourself you hate yourself, denying yourself basic needs e.g. food or things that might make you happy, hiding yourself from the world, self-harming.
• Non-violent / passive anger - ignoring people or refusing to speak to them, refusing to do tasks or deliberately doing things poorly, late or at the possible last minute; being sarcastic or sulky.

• Be aware of warning signs – these can be caused by the rush of adrenaline e.g. increased heart rate, increased breathing rate, increase in body tenseness, tapping of feet, clenching of jaws and fists.
• Buy time to think - ask student to step into a quieter location, but still with other people close by in case of escalation. Sit quietly with them, ask what has caused issues, talk to module leader / tutor /PAT.
• Try some calming techniques - distraction, slow breathing, relaxation, mindfulness techniques, use up energy in a safer way.
• Examine thought patterns - if feeling upset or angry a student might find themselves automatically thinking – that everything is all someone else’s fault, or people never listen to them, or this always happens to themselves…

• Be aware of warning signs – these can be caused by the rush of adrenaline e.g. increased heart rate, increased breathing rate, increase in body tenseness, tapping of feet, clenching of jaws and fists.
• Buy time to think - ask the student to take five minutes out before rejoining the session, or ask them to stay on/contact you after the session to discuss what caused the problem, calmly and rationally.
• Try some calming techniques - distraction, slow breathing, relaxation, mindfulness techniques, use up energy in a safer way.
• Examine thought patterns - if feeling upset or angry a student might find themselves automatically thinking – that everything is all someone else’s fault, or people never listen to them, or this always happens to themselves…

• It is not easy dealing with an angry person;
• Do not be vague when dealing with an angry person;
• Do not say things like “I understand what you are saying” or “I understand that because I have been there too”;
• Do not take the bait when dealing with an angry person – do not engage with the “argument” and take things personally;
• Do not blame them or criticise as this may inflame situations;
• Avoid the use of critical statements like “you always do……”;
• Avoid giving advice at the time as this may come across as criticism to an angry person.

• Physical - shakiness, trembling, muscle aches, sweating, cold clammy hands, dizziness, vertigo, fatigue, racing or pounding heart, hyperventilation, sensation of lump in throat, choking sensation, dry mouth, numbness, tingling hands or feet, upset stomach, nausea and vomiting, diarrhoea, decreased sexual desire, sleep disturbances.
• Psychological & social manifestations - jitteriness, tension, unrealistic or excessive worry, exaggerated startle reactions, fear of being away from home, irrational fears, avoidance of feared situations, recurrent disturbing dreams or nightmares, apprehension that something bad may happen to themselves or loved ones, impatience, irritability, distractibility, difficulty in concentrating, depression.

If you’re aware of a student with anxiety, there are a number of accommodations you could make to the classroom environment that may help them to deal with this. For example:

• Provide pre-arranged breaks to manage stress;
• Give advance notice of any tasks and ensure instructions are clear;
• Allow the student to answer the questions on which they feel the most confident – try not to single them out to answer ‘on the spot’;
• It may help to allocate students into groups for any group work, rather than allowing them to choose groups themselves;
• Follow-up on absences – if anxiety is becoming an issue, the students may miss classes to avoid facing the anxiety- which may create more anxiety in the long-run;
• Further suggestions around coursework and exams may be provided in a student’s PLSP, if they have a diagnosed and declared panic disorder.

For online students, you should also:

• Give advance notice of any tasks and ensure instructions are clear;
• In online tutorials, allow the student to answer the questions on which they feel the most confident – try not to single them out to answer ‘on the spot’;
• It may help to allocate students into groups for any group work, rather than allowing them to choose groups themselves;
• Follow-up on absences – if anxiety is becoming an issue, the students may miss classes to avoid facing the anxiety- which may create more anxiety in the long-run.

Don’t respond to worries by telling the student ‘don’t worry’ or ‘don’t be silly’- the worries and fears are real and serious to them – validate and accept their feelings e.g. “I can see that you’re very worried about this assignment”.