Over the past several decades, advances in medicine and therapy have allowed more people with mental health challenges to function as productive members of society, and to pursue higher education. The percentage of students receiving treatment for mental illness in college has risen from 9 percent in 1994 to 17 percent in 2000, and was 24.4 percent in 2012. The passage of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act will further improve access to mental health care, enabling more people with mental illness to stay on track to improve their economic prospects through higher education. This likely means that, in the near future, online instructors will encounter more students with mental health challenges in the online classroom. If the benefits of higher education are to be afforded to all, instructors should learn to recognize the signs of common mental health issues and to know their role in supporting online learners and their classmates with mental and emotional challenges and disabilities.
According to the National Alliance on Mental Illness (NAMI), “mental illness” is an umbrella term that includes a host of conditions that cause severe disturbances in thinking, feeling, functioning, and relating to others. Like physical health and illness, all of us have mental health to maintain, and mental illness is surprisingly common but underreported. Half (46 percent) of us experience mental illness in some form within our lifetime, including anxiety or depression. One in four (26 percent) experience at least one diagnosable disorder each year, and one in 17 (6 percent) experience a seriously debilitating mental disability each year. Stressors common to the college environment can exacerbate the symptoms of mental illness and can create short-term difficulties for students without chronic diagnoses. How a student copes can make or break their academic future. A student who experiences a difficult breakup or whose psychiatric medications are disrupted may lose their scholarship if they allow their GPA to fall during a depressive period, and lose the ability to pursue higher education in the future.
Despite this growing need to know how to work with online learners experiencing mental and emotional challenges, there has not been much written on the topic, and higher education institutions generally do not have the resources and policies in place to the extent that they do for their on-campus students, says Ken Einhaus, project manager at the Center for Applied Research Solutions who helps manage technical assistance and training for the California Community Colleges Student Mental Health Program (http://cccstudentmentalhealth.org).
The role of the online instructor is to be aware of the issues that affect the academic success of his or her students and to provide the support they need, not to serve as a therapist. One of the challenges of recognizing mental illness in one's online students is the lack of face-to-face contact. Lack of visual cues or verbal tone means instructors need to look for other indicators, such as:
- not logging into the class on a regular basis
- lack of participation in the discussion board
- missed assignments
- decrease in quality of work
- not taking advantage of opportunities to retake quizzes for a better grade
- undeliverable emails
- poor quality of postings
- rambling or nonsensical postings indicating a threat to self or others
- difficulty following written directions
- writing that could indicate mental turmoil
When an instructor observes two or more of these indicators, it's important to express concern and ask what's going on. For example, an instructor might write, “I've noticed that the quality of your work took a sudden dive three weeks ago. Is there something I can help you with? Is there something going on?” and then, if necessary, refer the student to the appropriate resources on campus or online (see the list of resources below).
It can be an awkward and unpleasant exchange, but, Einhaus says, it's better to offer and get a response of “No, thank you. I'm fine,” than it is to not get the student needed help for fear of offending him or her. “A well-intentioned offer of assistance will be more easily forgiven than the consequences of somebody needing help and not getting it,” he says. “I encourage teachers to take risks that way. Indicate that your door will be open to talk to students about any stress related to carrying out their assignments. That is a professional way to indicate that you are available to students to communicate their issues. But you want to be making observations within your realm as a teacher.”
When faced with a potential mental health crisis, it's important to know what resources are available to you as an instructor. Specifically, Einhaus recommends:
- Know the mental health referral policies and protocols of your institution, and know whom to contact.
- Be familiar with mental health resources that are available online.
- When you observe signs of distress, communicate with the student privately via chat, telephone, or email.
- Be mindful of any background knowledge you have of the student from the first-week introductions.
- Listen carefully and try to understand the student's perspective without agreeing or disagreeing. Identify the student's concerns as well as your own.
- Keep a written record of your concerns and interventions, as well as the student's responses.
- Share your concerns with your institution's behavioral intervention team (BIT) if it has one. BITs are groups of key staff and personnel who convene on a regular or as-needed basis to discuss incidents of concern.
“BITs are basically the way for teachers to get help because teachers are not going to have this training. Teachers can be trained to conduct brief assessments, do standard referrals, and understand what mental health problems look like, but they're not ultimately going to, and should not be expected to, provide therapy,” Einhaus says. “Ideally the campus would have some kind of system for that, and it wouldn't be all on the teacher. The teacher would just have a smooth handoff. I think ultimately that's going to happen. The problem in the interim will be the teachers who are teaching for institutions that don't provide mental health services to any degree, especially in an online setting. That's where we have to work around those problems. Hopefully, the teacher will have somebody with some psychological training on hand to know what that student needs [in order to] to stay in the course.”
The California Community Colleges Student Mental Health Program is funded by the voter-approved Mental Health Services Act (Prop. 63). It is one of several Prevention and Early Intervention Initiatives implemented by the California Mental Health Services Authority (CalMHSA), an organization of California counties working to improve mental health outcomes for individuals, families, and communities. For more information, visit www.calmhsa.org.
Online Mental Health Resources
Einhaus recommends the following online mental health resources:
