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Identifying and referring the distressed student

Information for Faculty, Staff, and Students

Stress seems to be an especially common feature of college student life. Usually minimal degrees of stress motivate individuals into productive action; maximum degrees of stress, on the other hand, often result in little or no productive outcomes.

This information is not intended to be an exhaustive treatment of the topic. However, it can be of considerable value regardless of the perspective from which you interact with students or peers if you are a student.

Please call (808) 934-2730 or come to the Counseling and Support Services Center on the Manono Campus in Bldg. 379 if you would like to discuss any general or specific student stress situations. None of the current counselors is a licensed mental health counselor. However, as educators they are skilled in teaching stress management. For more seriously distressed students the counselors can be of initial assistance in providing support, assessing the situation, and making any necessary referral for mental health services.

Signs of Stress [notice patterns - recurring behavior, continued behavior]


  • Withdrawal from usual social interactions
  • Decreased productivity
  • Increased mistakes
  • Noticeable absence from class
  • Emotional outbursts and crying
  • Loss of interest or apathy
  • Exam time "jitters"
  • Increased or decreased sleep
  • Exaggerated irritability
  • Depression
  • Excessively blaming others
  • Excessive hostility, anger or resentment
  • Obsessions (unwanted thoughts)
  • Excessive worrying or expression of fears
  • Increased forgetfulness
  • Confusion
  • Thought disorders (the student’s conversation does not make sense)
  • Compulsive disorders (ritualistic ways of acting, such as twitches, repeated words, excessive hand washing)

Physical Symptoms

  • Elevated blood pressure
  • Chronic digestive problems/stomach pains
  • Increased muscle tension
  • Severe and frequent headaches
  • Dizziness
  • Elevated pulse and respiration
  • Ulcers
  • Moist or sweaty palms
  • Increased frequency of urination
  • Questions about sexually transmitted diseases and/or pregnancy

Personal Relationships

  • Death of a family member, partner or close friend
  • Difficulties in marital or dating relationships
  • Difficulty in family relationships
Alcohol and Drug Abuse/Dependence

References to Suicide

How to Help a Student under Stress (non-emergency)

1. Be available.

2. Listen with care, attention and acceptance from the student’s perspective, rather than your own. Develop an "adult-adult" approach rather than a "superior-subordinate" approach. Use reflective statements, i.e., share with the student what you hear him or her saying.

3. Help the student define what is causing the stress, the effects of the stress, what he or she is doing to cope and how effective the coping skills are.

4. Before offering suggestions or advice, encourage the student to think of coping methods he or she has found effective in the past or which might be effective in dealing with the current stressors. Doing so empowers the student to rely on his or her own judgment and to assume responsibility.

5. After the previous items have been discussed, you can suggest alternative ways of viewing the situation and other ways of coping with or minimizing the stress. (See "Means of Coping with Stress" below.)

6. Take the time to follow up with the student, i.e., asking generally how the student is getting along. Do so in an interested, concerned and adult-adult manner, not in a paternal manner.

7. If it seems that the student has made little or no progress with resolving the stress situation or employing various coping mechanisms, refer the student to the Counseling and Support Services Center or to other appropriate resources off campus.

8. Call a Counselor or another referral source to discuss a student’s situation. In that way, not only will you help the student deal more effectively with the problem, but you will also prevent the possibility that you will become part of the student’s problem. It is more beneficial to the student if you are aware of your limitations and, thus, know when and how to appropriately access referral sources.

Don’t wait until it is too late for someone else to help!

Means of Coping with Stress

1. Eat a balanced diet, get a good night’s rest, and exercise regularly. Get regular physical examinations. When we feel "good," we not only are able to deal with problems more effectively, but also to interpret problems as less severe.

2. Set realistic academic and personal priorities, and reevaluate them periodically. Don’t overload yourself with unimportant responsibilities or tasks. Be flexible!

3. Don’t wait until the last minute to do things! Plan your day and week so that you are able to accomplish the necessary tasks and comprehend all the responsibilities and activities that lie before you.

4. Consider alternative ways of viewing your situation. Sometimes it is not the situation but the particular way you interpret it that creates undue stress. This is essential if you happen to be the "catastrophizing" type of individual, i.e., one who often interprets events or problems as crises.

5. Try at various times each day to "get outside yourself," i.e., listen to and concentrate on others and think about other external events. Constant preoccupation with oneself is sometimes quite counter-productive.

6. Balance your social time with some alone time. Experience what it means to feel good about being yourself.

7. Engage in prayer or meditation.

8. Read self-help books that address the area of life that is causing you stress.

9. Learn effective relaxation exercises through books, tapes or classes. For example, changing one’s breathing to slow and deep rhythm can bring calmness.

10. Learn more productive reading and study skills. Call the Learning Center at (808) 974-7503.

11. Engage in individual activities that are pleasurable and provide a diversion, such as TV; hobbies; reading; exercising; going to a movie, play, or concert; listening to or playing your favorite music; hiking; eating out for a change, etc.,

12. Be aware of your support system: friends, family members, professors, counselors, etc., and be willing to ask them for help.

13. Attend the church or synagogue of your choice, or talk to a minister, priest, or rabbi.

14. Get involved in volunteer work or do something helpful for someone you know.

15. Learn about the campus resources that are available to you. Go to the Counseling and Support Services Center to learn about these services.

16. Be careful not to fall into the trap of thinking and feeling that you are "all right" only when everyone else "approves" of you.

17. Engage in social diversionary activities like athletics; dancing; participating in social, special interest, or religious groups; taking short trips; playing games, etc.,

18. Be selective about the people with whom you choose to share your concern. Talk to trusted, mature, and experienced people who may have dealt with concerns similar to yours, or who can offer honest, responsible feedback. They can sometimes give tips and perspectives that can help you accomplish a task or deal with a situation, thus, reducing the stress and anxiety you feel.

19. When given advice, always remember that you are not obligated to follow it; after all, you are ultimately responsible for yourself, and what happens to you. Learn to rely on your own judgment and remember this takes practice and patience with yourself.

How to Refer a Student for Further Help (non-emergency)

When to Refer

  • When a student presents a problem or a request for information that is beyond your level of competency
  • When you feel that personality differences (which cannot be resolved) between you and the student will interfere with his or her effective progress
  • When the problem is personal and you know the student as a friend, neighbor, etc.
  • When the student is reluctant to discuss his or her problem with you for some reason
  • When, after a period of time, you do not believe your work (communication) with the student has been effective

Don’t wait until it is too late for someone to help!

How to Refer

  • Build rapport with the student. Let the student express his or her feelings, and if necessary, calm down. This step may include a statement of your intention to help and observation and identification of behaviors symptomatic of distress.
  • Determine the problems, how long they have existed, which problem is most pressing, and the student’s resources, (e.g., the student’s success in resolving similar problems, the availability of friends, family, etc.). If the problem appears serious and longstanding and the student does not currently have effective coping skills, a referral is appropriate.

Making the Referral

  • Raise the issue of seeking outside help.
  • Assess the student’s reactions to this suggestion.
  • Ask the student which outside source he or she sees as most appropriate for dealing with this problem.
  • If the student is unaware of sources of help, suggest in a caring, concerned, and forthright manner the most appropriate service or person. Describe what the agency is like.
  • Observe the student’s reactions to the referral, and answer questions he or she may have about the referral. Convey positive but not exaggerated expectations of help from the referral, and deal with their fears about contacting this helping source.
  • Specify the procedures involved in contacting the agency, including the who, when and how of making the referral, or allow the student to use your phone to arrange the appointment. Making his or her own appointment reinforces the student’s sense of self-responsibility.
  • Always secure the student’s permission before passing information about the student on to the counselor.
  • Solicit agreement from the student to follow through on the referral.
  • Check with the student to see if the referral was followed up, and is working out. Don’t press the student for information. You can expect to receive consultation from the counselor/therapist on how best to interact with the student in future relationships if this information is so desired or necessary.
  • Don’t expect the immediate resolution of particular symptoms or problems. It may be a process that moves slowly.
  • Finally, respect the individual. The basic approach to all counseling and referral is one of fundamental respect for the individual, and the belief that it is best for that person to work out his or her problems in an individual way. You and the counselor are helpers in this process by providing a variety of alternatives for assistance on the student’s own terms. He or she may choose to ignore or accept the help available. Your role is to see that the student becomes aware of this help and has the maximum opportunity to utilize it.

To Whom to Refer

Find out which person or agency is most likely to best serve the student, before referring the student.

  • UH Hilo Student Health Services (808) 932-7369
  • HawCC Counseling & Support Services Center (808) 934-2730
  • Kokua Counseling Services (808) 934-2735
  • Hilo Adult Mental Health Services (808) 974-4300
  • Other counseling services are listed in the telephone directory.

Crisis Procedures

Emergency Situation – Threat of Harm

  • A student has questions about sexually transmitted diseases and/or pregnancy.
  • If a student has been taking about harming himself/herself, or another.
  • If a student is engaging in any type of self-destructive or psychotic behavior, consult with a Counselor about mandating a referral for an evaluation.
  • UH Hilo Student Health Services (808) 932-7369
  • Suicide Prevention Lifeline 1-800-273-TALK
  • Adult Mental Health Division ACCESS 1-800-753-8879

Emergency Situation - Harm

  • If a student engages in any type of self/other-destructive behavior; or exhibits overdose, tissue damage, vomiting and/or fluctuating levels of consciousness due to severe intoxication, call immediately for help.
  • Call 911 and ask for police and emergency medical assistance.
  • If the student is threatening or engaging in self-destructive behavior, stay with the student until he/she is assisted by paramedics or a mental health professional.
  • Notify the Vice Chancellor of Student Affairs at (808) 934-2509.

*Adapted from Hawaii Community College - Vice Chancellor of Student Affairs (5/14).