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Students with a psychological disability

"The line between mental health and illness is blurred; much is to be learned from one another across that line. Our understanding of the human condition is enhanced in an educational environment that values diversity of experience and expression and fosters, through support policy and practice, the intellectual and personal growth of all who work and study." (Hoffman & Mastrianni, 1989)

Psychological disability often develops between the late teens and early twenties. Tertiary students, therefore, can be a particularly
susceptible group. The impact of psychological disability can disrupt educational plans causing students to withdraw from their course or take a part time subject load.

Psychological disability can affect the student's ability to think and relate to other people and can be characterised by feelings of despondency, anxiety and fear. These feelings may be so overwhelming that coping with everyday activities becomes difficult. The student may at times be unable to differentiate between reality and fantasy and may have difficulties with organising their thoughts.

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General information about psychological disability

Definition

The Disability Discrimination Act (1992) defines psychological disability as "any condition which affects a person's thought processes, understanding of reality, emotions or judgement or which results in disturbed behaviour, for example, a person with a psychological disability, neurosis or personality disorder".

Psychological disability can include

  • mood-related disorders (depression, bi-polar)
  • anxiety- related disorders (phobias, panic, posttraumatic stress, obsessive compulsive behaviour patterns)
  • psychoses (schizophrenia)
  • personality disorders (borderline personality disorder and anti-social personality disorder)
  • eating disorders (bulimia, anorexia nervosa)

Under the Mental Health Act NSW ( 1990), psychiatric disability is referred to as:

A condition which seriously impairs, either temporarily or permanently, the mental functioning of a person and is characterised by the presence of one or more of the following symptoms:

  • delusions
  • hallucinations
  • serious disturbance of mood
  • sustained or repeated irrational behaviour indicating the symptoms mentioned above.

Due to the episodic nature of many psychological disabilities, students may function very well for long periods and then suddenly encounter difficulties.

Some students may have a long history of psychological disability, have experienced hospitalisation, be taking medication and/or undergoing psychotherapy. These students will often require ongoing assistance whilst studying such as examination accommodations, extensions of assignment deadlines, copies of lecture notes to cover periods of absence and a quiet area in which to rest.

Other students may experience their first episode of psychological disability whilst at university. Similar accommodations, such as additional examination time, increased flexibility about assignment deadlines or notetaking assistance in case of absence, will help at this time but may not need to be an ongoing service.

Often medications prescribed for the above conditions have side effects that negatively impact on study, eg difficulties with concentration, blurred vision, impact on short term memory, and/or induce physical symptoms like dry mouth, nausea, tremors and insomnia.

Myths about psychological disability

  • students with psychological disability are dangerous
  • students with psychological disability are likely to use more services than other disability groups
  • students with psychological disability are more likely to be disruptive
  • psychological disability = intellectual disability
  • providing services to students with psychological disability compromises academic integrity

Realities

  • few students with psychological disability are dangerous to themselves or others
  • students with psychological disability do not use more services than students from other disability groups
  • most students with psychological disability are not disruptive in lecture or tutorial situations
  • limitations are NOT intellectual, although the illness can interfere with cognitive functions and the learning process
  • services assisting students with psychological disability provide them with the opportunity to continue studying on an equitable basis
  • psychological disability manifests uniquely to each person
  • low self-esteem as well as fear of a recurrence of illness are common
  • self doubt or fluctuating levels of confidence
  • one in four people will undergo some form of psychological disability during their lives

Impact of mental illness on learning

Common difficulties associated with psychological disability can include:

  • decreased concentration, confusion and disordered thinking
  • difficulties with self-perception and perception of others
  • mood highs and/or lows
  • sensations of pain, torment or loss of sense of reality
  • fluctuations in motivation
  • reacting to all of the above in ways that others don't understand
  • embarrassment, low self esteem and experiences of isolation
  • side effects of medication prescribed to manage symptoms

There is an increasing range of services now provided to students with psychological disability at tertiary institutions. These services assist students to manage their illness and continue with their studies.

Disclosure and confidentiality

Within the tertiary education sector, unlike the primary and secondary system, self-advocacy and disclosure are ultimately the responsibility of the student with a disability, and the institution cannot force a student to disclose.

Many students with psychological disability are unwilling to self identify, as they are apprehensive about being stigmatised and discriminated against. Fear of breach of confidentiality also acts as a deterrent to identifying.

The institution's role, therefore, is to develop policies that promote an atmosphere of acceptance and trust, and ensure that services are provided in a confidential manner.

University staff members should not expect to obtain information about any student from a counselling unit. Confidentiality between Counsellors and the users of these services requires a formal permission to release information to a third party signed by the client. Confidentiality can only be breached in the following circumstances:

  • if direction is given by the client to disclose information to a third party or parties. This direction must in the form of a signed statement by the client.
  • if it is a legal requirement eg a response to a legal subpoena for documents to be produced or for the counsellor to appear before a State or Federal Court. Other circumstances would include an over-riding legal requirement to breach the understanding of confidentiality. These circumstances would normally involve statutory obligations, illegal or criminal activities or the prevention of harm to others.
  • if there is an issue of duty of care. This occurs when the counsellor and/or their direct supervisor consider the client's behaviour to be a danger to themselves or others.

Recognising a student with a psychological disability

Behaviours that may be indicative of various mental health problems are:

  • withdrawal from activities
  • impaired concentration
  • fluctuating attention
  • irritable behaviour
  • weight loss
  • persistent sadness and tearfulness
  • worry and agitation
  • aggressive behaviour
  • lack of interest in life
  • inappropriate behaviour including
    disruptive or anti-social
  • delusions (false beliefs)
  • grandiose behaviour
  • extreme euphoria

The above behaviours may indicate a psychological disability. However, a diagnosis can only be arrived at through an intensive interview process with a therapist or medical practitioner.

Disruptive or aggressive behaviour

When a student exhibits difficult behaviour, academic staff may not initially consider that this behaviour could be symptoms of a psychological disability. These situations can be associated with highly disruptive behaviour in lectures, sometimes including threats of violence or perception of imminent danger. However, this type of behaviour is uncommon.

Disruptive behaviour will prevent other class members' ability to concentrate and participate in the lecture or tutorial, and staff and students may often feel powerless to act. However, any student behaving in a disruptive manner should be asked to leave the lecture or tutorial and the lecturer should speak to them privately at a later time.

At that time, the staff member could suggest to the student that they go to the Counselling Unit and/or make a referral to the Unit if the student agrees.

If the behaviour is aggressive and threatening, or poses a danger to themselves or others, campus security may need to be notified.

It should be noted that students without a psychological disability might also display aggressive or disruptive behaviour.

Students at Risk

A student who appears depressed, expresses feelings of hopelessness and helplessness, whose behaviour seems to have changed significantly or talks or hints at committing suicide should be taken seriously. Staff should consult the university counselling unit to find out effective ways of dealing with the situation (which could include actively encouraging the student to see the counselling unit).

Whilst the above behaviours can indicate that a student may have a psychological disability, many students with mental health problems will show few outward signs.

Unfortunately, a student with severe psychological disability is more likely to express their difficulty through absence from class and/or gradual withdrawal from university life. It is important that the student be referred to Counsellors by academic or general staff if an opportunity arises.

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Teaching strategies with a psychological disability

Academic staff have found the following strategies useful when working with students with psychological disability:

Large groups

  • A student may have difficulties coping in a large lecture situation, and may have difficulties attending. In this case, tapes, copies of lecturer's notes or a notetaker can assist.
  • Tapes and notetaking may also be useful if a student has a period of absence from their course.
  • Changing the weighting on examinations and class participation.

Small groups/tutorials

A student may have difficulties participating in tutorials because of withdrawal or communication difficulties. Strategies include:

  • adjusting attendance requirements, ea. tutorial attendance
  • asking the student if they require clarification of any points as the illness or medication can cause difficulties with concentration
  • allowing the student to substitute tutorial presentations with written work
  • if the student will have difficulty in contributing and participating because of their disability this could be managed through the student consulting with the Disability Services Officer or Counsellor to obtain a recommendation to lecturers on how best to assist the student

Distance learning

Where university courses are offered through distance learning, it may be possible to offer the student this mode of study on a temporary or permanent basis.

Laboratory and/or field work

Anti-depressant medications can cause drowsiness or affect ability to concentrate. This create difficulties for the student in handling chemicals, equipment or machinery or undertaking fieldwork, therefore alternative assessment could be granted, where possible, or the student be allowed to do the work at a more suitable time.

If you are aware that the student is taking medication that may affect their ability to operate machinery speak with the student privately and ensure that all relevant staff are informed.

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Alternative assessment strategies for students with a mental illness

Students who may have difficulties doing written examinations could be offered alternatives, eg verbal examinations, audiotape presentations or additional assignments could substitute for examinations.

Students choosing to do examinations can it required be offered additional time for writing or rest breaks and a separate room in which to do the examination.

Assignments

Extension of deadlines for assignments and essays can also help students with psychological disability by alleviating stress.

Examinations

  • additional time for examinations
  • separate room in which to sit the examination
  • permission to have rest breaks during the examination
  • permission to sit examination outside of the usual examination period
  • permission to replace examinations with other forms of assessment
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Other Strategies

  • suggest to the student a part time subject load my be appropriate if they are falling behind or failing
  • where possible, staff making time to see students in need without a prior appointment
  • extra tuition
  • help with organising administrative details, such as deferring, withdrawing without failure or adjusting subject load
  • flexibility with timetabling where possible, as students taking medication often find attending morning lectures very difficult
  • a quiet safe area for the student to go to when stressed
  • staff training to increase understanding and awareness of psychological disability
  • assistance with arranging peer support/peer mentoring
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Self-Help Strategies

Suggest to the student that they might consider:

  • seeking assistance from the Disability Services Officer on campus
  • learning stress management/relaxation techniques
  • seeking help with study skills, eg from the Learning Centre on campus
  • establishing a small student study group
  • establishing a supportive relationship with a university counsellor
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