Student Referrals: How and When

Laura B. McGrath is a PhD student in English at Michigan State University, specializing in modernist literature and media studies. She tweets at @lbmcgrath and blogs at Emerging Modernisms.

Many of us regularly refer students to different university services. Without batting an eye, I’ve encouraged students to visit the University Writing Center, to set up a meeting with a subject librarian, or to see a tutor in the English Language Center. These fantastic services can offer more specialized attention than I am able to give, and I’m so grateful for their partnership.

But other types of referrals are not so concrete: What do you do, for example, when a student confesses that s/he has recently suffered some sort of trauma? Or when a student writes about illegal activity in a paper? Or when you notice fresh self-injury scars as you talk with a student after class?

In recognition of Mental Illness Awareness Week, I want to take the time to address the ways in which we graduate students can respond to mental or emotional crises, particularly those exhibited by our students. Part of creating a culture that is supportive to mental and emotional Health means being willing to promote healthful behaviors in those around us—our students, our friends, and our colleagues.

There are plenty of situations in which you might find yourself privy to information about your students’ mental health. As a TA, you probably appear more approachable than many professors. Even the simplest of questions (“How are you doing today?”) can open a floodgate: death in the family, stress and anxiety, financial difficulties, eating disorders, you name it: our students are going through some tough stuff, and we shouldn’t take it lightly. Often times, students are simply looking for someone to care, someone who will listen to them, and someone who believes they matter.

Let me assuage your guilt right now: you are not responsible (nor are you equipped) to personally respond to students’ mental health crises. There are a host of professionals at your university who are equipped to counsel, advise, and treat. My partner happens to be one of these student affairs professionals: his day is filled with escorting students to the counseling center, mediating roommate and student-parent conflicts, and working with Academic Services to get students the help that they need. I see how hard he works, and I know each of his colleagues is just as dedicated to student success. Bottom line: there are people who know what they’re doing, and whose lives are dedicated to doing it.

I do not say this to be callous, or to pass the buck. Quite the opposite: I say this as one who gets carried away by empathy, who wants so badly to help, and who has had to learn to let go. I applaud your desire to walk alongside your students in a difficult time, but it’s ultimately better for both of you if your student gets connected with the professional help s/he needs. To top it off, you might be dealing with your own mental health concerns, and are in no place to advise a student. Advising a student might constitute a major conflict of interest.

Here’s my advice, then, on how you might go about addressing these difficult subjects with your students. In compiling this list, I researched a number of counseling centers from universities around the country, and found that the referral process did not vary substantially from institution to institution. I encourage you to research your university’s policies before referring a student.

When to Refer

It’s not always easy to know when a student needs to be referred. Here are some situations in which a referral might be necessary.

• After A Conversation. Always talk to a student about your concerns before making a referral. There are lots of explanations for classroom behavior: what looks like a mental health concern might simply be a hangover. If a student tells you directly that s/he is in distress, make the referral.
• If you’ve noticed major behavioral changes or disruptive behavioral patterns. This may be a response to major life changes or emotional distress. Students might be withdrawn or agitated in class, they might stop attending or submitting assignments, or their behavior might be erratic (spontaneous laughing or crying, hostility, etc.). A simple question after class or in office hours, such as “I noticed that you seemed to be x in class. Is everything all right?” should offer some clarity.
•  References to Suicide. You should always take references to suicide seriously. You should ask directly if a student is having suicidal thoughts, especially if s/he has discussed this openly in a classroom environment or in a paper. Yet students rarely offer up this information on their own; if you become concerned, based on other comments they’ve made or their behavior, you should ask. If a student has a specific plan, call your counseling center immediately.

How to Refer

• In case of emergency call 911 before calling your campus counseling center. Have the counseling center number available, ask the student to call while in your office, and identify her/himself as a student in need of immediate assistance. You may also consider escorting a student to the counseling center yourself.
•  Before your meeting, do the leg work. Obtain the appropriate phone numbers, and consider speaking to a counselor beforehand. Minimize any difficulty that the student might face in getting the proper help, and facilitate a smooth process.
• Speak to the student about your concerns. It’s best to be specific about what, exactly, concerns you. If you are concerned about a student, but are unsure how to express your concerns specifically, begin documenting the behaviors that concern you.
• Listen, listen, listen. Avoid judgment, and express support. Let a student know that it’s OK to ask for help.
•  Emphasize confidentiality. Students should know that professional counseling services are confidential.
•  Be careful, however, that you do not make promises about your confidentiality; this is especially important if a student poses an immediate threat to themselves, or others.
• Remember, a referral is only a suggestion. A student can refuse treatment if s/he does not believe it is necessary. If a student agrees to a referral, s/he must be the one to set up the appointment.
• Follow-up. Continue to show your support for this student by inquiring about his/her meeting. This is to be sure that a student made an appointment, not to ask any specifics about the nature of the meeting. Don’t pry, but your continued attention will be an encouraging show of support.
•  Let go. You’ve done what you can to connect a student to appropriate campus resources. Now it’s time for you to let the professionals do their job, and the student take responsibility for his/her own treatment. Teach and grade appropriately.

These situations are never easy. They can be uncomfortable, they can be heartbreaking, and they can be infuriating. But don’t let the fear of discomfort stop you from getting involved if you suspect a student is in need.

What other advice do you have for addressing mental health concerns? What barriers have you faced in responding to student mental health concerns? What hesitations or fears might you have? Have you had positive experiences in discussing mental health with your students? Leave your responses in the comments below. 

[Image taken by Flickr user Joe Houghton and used under the Creative Commons License]