In 2015, at the NAFSA Region II conference, Jenifer Frankel (from International Student Insurance), Linda Melville (from the University of New Mexico) and Chalimar Swain (from the University of Utah) presented on the topic of "Improving Mental Health Awareness Among International Students"

1. NAFSA Region II Conference 2015
Improving Mental Health
Awareness Among
International Students

2. Presenters
Jennifer Frankel
Linda Melville
Chalimar Swain

3. Agenda
Achieving Mental Health: Creating Awareness
Second-level Support: Mental Illness
Helping Students Seek Care/Barriers
Resources/Best Practices
Case Studies and Discussion

4. Achieving Mental Health:
Creating Awareness

5. What is Mental Health?
Mental health is “a state of well-being in which the individual realizes his or
her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her
community.”
- Centers for Disease Control and Prevention

6. Challenges for International Students
Far from family and friends
Values are being challenged
Need to reformulate identity & personality
Challenge to skills & abilities
May have studied abroad to avoid problems at home

7. How Can We Assist?
Make them aware of the challenges
Help them to create a support system
Inform them about campus and community resources
Offer workshops to help cope with common stressors
(culture shock, academics, etc.)
Educate campus staff

8. Types of Programs that Help
Buddy/Peer mentor programs
Culture shock workshops
University 101-type courses
Social organizations/student clubs
Holiday programs
Friendship family programs
Staff training

9. Train Advising and Office Staff
Discuss common issues
Teach active listening
Encourage empathy
Create a plan of action
Remind staff to be courteous and friendly
Create a welcoming environment

10. Second-Level Support:
Mental Illness

11. 0
5
10
15
20
25
30
35
40
45
50
Experienced Emotional/Stress Related Problems
Considered Seeking Care
Actually Sought Care
44%
33%
17%
(Source: Hyun, Quinn, Madon, & Lusting, 2010)
International Students Are Not Seeking Care

12. Commonalities with US Students
90% of students who seek counselling improve within 6 months
Issues are similar, most common include:
Anxiety related to performance
Fear of failure
Finances
Source: Data from UNM Counseling Center

13. Unfamiliarity with US systems
Physical differences that set them apart (hijab)
Political systems can make them feel implicated
Differences from US Students

14. What is Mental Illness?
Mental illness is defined as “collectively all diagnosable mental disorders” or
“health conditions that are characterized by alterations in thinking, mood, or
behavior (or some combination thereof) associated with distress and/or
impaired functioning.”
- Centers for Disease Control and Prevention

15. Mental Illness – Birds Eye View
Source: National Institutes of Health, 2013 Source: World Health Organization, 2002
450 million people affected
Almost 50% affected

16. Helping Students Seek Care:
Eliminating Barriers

17. “Adequate orientation and administrative support for international students are key factors
in successful transitions.”
(Source: Hyun, Quinn, Madon, & Lusting, 2010)
Yes No
39%
61%
Knowledge of Campus Counseling Services

18. Worldwide Stigma
Mental illness often
goes undiagnosed
and untreated
among
international
students due to the
negative
connotations
associated with the
subject around the
world.

19. Common Myths
“Counseling is for crazy people.”
“Everyone will know I saw the counselor.”
“I can handle my own health problems. If not, it
means I’m weak.”

20. An Advisor’s Role and Boundaries
“International students who reported a more
functional relationship with their advisors were less
likely to report having an emotional or stress-related
problem in the past year and [to report] using
counseling services...”

21. Warning Signs
Change in Appearance
Academic Problems
Social Isolation
Noticeable Changes in Mood
Unusual or Odd Behaviors
Drug/Alcohol Abuse
Threat of Harm to Themselves or Others

22. Helping Students Seek Care
On-campus assistance:
Mental Health Staff
Hours
Average Cost
No counseling center?
Relationships with other providers
Suggestions from other departments
Helplines

23. Insurance and Mental Health
What is Legally Required?
Nothing!
Mental health insurance
coverage is not required by the
government for international
students.
Questions to Consider:
1. Do the students’ insurance
plans cover mental health?
2. Does the insurance
company offer language
support?
3. Do students realize that
claims are confidential?

24. Best Practices & Resources

25. Best Practices: Awareness & Action
1. Train advisors to spot red flags
• Numerous/repeated failed courses
• Difficulty sleeping/sleeping too much
• Isolation
• Requesting a medical RCL/LOA
2. Understand the “international” component
• Cultural coping strategies/ perceptions of resources
• Additional stressors or factors impacting primary issue

26. Best Practices: Awareness & Action
3. Indentify resources & protocols
• CARE Team
• Counseling Resources
• Other Resources
4. “High Touch” assistance and follow through
• Refer to another person, not another office
• Demystify processes (i.e., counseling center intake)
• Follow-up to see how things are going

27. Best Practices: Awareness & Action
5. Set boundaries
• Refer as appropriate
• Understand your capabilities and triggers
• Be clear about your role
6. Interdepartmental outreach
• Help others understand international students’
unique needs

28. Best Practices: CARE Team
Centralized team: indentifies and provides support for escalated issues
1. Centralized response/tracking for situations of concern; including
referrals to/coordination with specific resources needed
2. Coordination of support and response; ensure multiple perspectives:
• Multicultural sensitivity
• Social and emotional wellbeing
• Academic outcomes
3. Training opportunities for ISSS staff: holistic response to advising

29. Best Practices: CARE Team, con’t.
Meets weekly, discusses current student situations, formulates action plans and assigns
follow-up
Care Team does NOT:
1. Provide mental health treatment or assessment
2. Adjudicate conduct issues
Structure
3 permanent members (Director, Associate Directors)
2 rotating members (advisors, GA’s)

30. Resources and Awareness
Mental Health Awareness Video Resource:
www.internationalstudentinsur
ance.com/explained/mental-
health-video.php
NAFSA provides the following
publications:
Health and Wellness for
International Students
Best Practices in Addressing Mental
Health Issues Affecting Education
Abroad Participants
www.nafsa.org/Find_Resources/

31. Resources - National Hotlines
National Suicide Prevention
1-800-273-TALK
www.suicidepreventionlifeline.org
Substance Abuse and Mental Health
Services Administration (SAMHSA)
1-800-SAMHSA-7 or 1-877-726-4727
www.samhsa.gov
It Gets Better Project (LGBTQ)
1-866-4-U-TREVOR (866-488-7386) or 1-888-
843-4564
www.itgetsbetter.org/pages/get-help also
includes state specific resources
https://www.nami.org/Find-Support/LGBTQ
The National Domestic Violence Hotline
1-800-799-SAFE
http://www.thehotline.org/

32. Case Studies & Discussion

33. Case Study #1
During an appointment with a student to discuss her request for a reduced
course load (RCL), the student tells you that she needs to drop at least one,
and maybe more courses. When you ask her why, she is vague, stating that
she is having trouble with the topics. You notice that last semester, she had
failing grades in 3 out of 4 courses. You mention this, and ask her if anything
specific is causing her difficulty. She says she’s having trouble sleeping at
night and is very tired each day and can’t go to class.
What follow up questions could you ask?
What resources could you offer?
What possible mental health issues might you be aware of?

34. Case Study #2
Julio, an exchange student from Spain, seems to be constantly in the office.
Several times, he has spent up to two hours speaking with an advisor. He also
attends all of your workshops and social events. He appears to be very
extroverted and nice, if perhaps a little needy. About two months after the
start of the semester, you notice that Julio is in the office every day, often
meeting with one particular advisor or sometimes just “hanging out”. Soon
after, the advisor comes to you and expresses concern about the things Julio
is telling her. He seems to be having major issues with his family at home, and
is very lonely and isolated. Lately she’s also noticed that Julio looks disheveled
and unkempt. The advisor doesn’t really feel comfortable with the amount of
time he’s spending with her, but she’s hesitant to bring anyone else in because
“Julio trusts me”. What are the issues? What actions should you take?

35. Thank you!
Q&A