Distressed Student Protocol

Truckee Meadows Community College is dedicated to ensuring that staff, faculty and students work and learn in an environment that is safe, respectful, and responsive to those in distress. This protocol document provides guidance to staff, faculty and students to identify and assist students in distress.

TMCC is committed to providing resources to ensure that a student in crisis is responded to quickly, responsibly and in an empathetic manner. A distressed student may also display disruptive behaviors, which are covered by TMCC’s Student Conduct Policy, and will not be addressed directly by this protocol. This protocol is designed to provide guidance to the campus community.

It defines how to:

  • Recognize the signs that a student may be in distress;
  • Establish a consistent framework for responding to the student in distress;
  • Facilitate access to after-care and reintegration to the campus community for the student after the immediate crisis is addressed;
  • Ensure a coordinated crisis response and review process.

The TMCC Counseling Center is also your first point of contact in many of these situations.


Signs of Distress

Students experiencing psychological or emotional distress may exhibit behaviors that would be out of the ordinary for the student and/or considered socially inappropriate or strange. Use of drugs or alcohol may also mirror these symptoms and the distressed student will still benefit from intervention.

Behaviors may include:

  • Repeated or excessive disruptions (hostile or antagonistic behaviors)
  • Inappropriate or exaggerated emotional responses to a given situation including lack of emotional response to a stressful situations
  • Loss of contact with reality including rambling or incoherent speech, laughter that is out of context, visual, tactile or auditory hallucinations
  • Significant decline in academic performance
  • Change in interaction patterns in the class
  • Frequent attempts to obtaining postponement of tests or extensions on assignments that are due

In addition, individuals who are in distress are at greater risk of suicide especially when behaviors are new or have increased, often in response to a recent painful event, including loss or changes.


Confidentiality

A student in distress has a right to privacy. In most situations, information provided by the student is confidential and is only released with student permission.

Written records, including student conduct reports, are protected by the Family Education Rights and Privacy Act (FERPA). Except in extraordinary circumstances, permission to release this information is to be given by the student in writing via an Authorization to Release Information form.

FERPA, and the code of ethics adhered to by the TMCC Counseling Center, does permit the release of information when necessary to protect the health or safety of the student or others.

When a student presents an imminent danger to self or others, it is both permissible and crucial to notify the University Police Services (and/or call 911) and the student’s emergency contact.


Responding to the Distressed Student

Individuals in distress are often more ready to receive intervention during a crisis. The responder may be able to take this an opportunity to reach out to the person to help by connecting the individual to available resources such as: the TMCC Counseling Center, veterans resources, low-cost clinics, faith-based supports and other community partners including those serving specific populations (e.g., LGBTQI).

The responder may be able to assess the risk and determine the level of intervention and/or resources needed by following these steps:

In An Emergency After Hours
When a student is presenting an immediate danger and/or access to lethal means contact the University Police Services (775-334-2677).

Since University Police Services are on campus, they may be able to respond more quickly.

If the student has a concrete plan and means to carry it out or has done something that has the potential for death, respond immediately: call 911 and University Police Services 775-334-2677 (if you call 911 first, be sure to also call University Police Services as they are located on campus and may be able to respond more quickly).

If there is not an immediate danger, there are four options, depending on the level of concern:
  1. Contact the University Police Services (775-334-2677) to assess the situation and determine if immediate action is necessary. 
  2. Call the Crisis Call Center (800-273-8255) to connect the distressed student with support right away.
  3. Leave a message at the TMCC Counseling Center (775-673-7600) requesting that a counselor return your call (note: this will not happen until the next business day).
  4. Make a report electronically using the Public Incident Report form.

Resources

Counseling

The TMCC Counseling Center coordinates prevention, intervention and post-intervention services for students. The Counseling Center, located in RDMT 325 and available during regular business hours, also provides consultation to faculty, staff and concerned others regarding how to assist a student who is displaying behavior that is raising concerns.

Faculty and staff in need of counseling services for themselves are referred through Human Resources to the Employee Assistance Program (EAP).

Distressed students, and those concerned about a student, are encouraged to come to, or call the Counseling Center. In crisis situations, the Counseling Center receptionist will follow Counseling Center protocol to locate either an available counselor or the counselor on call. Please be certain to notify the receptionist that you have an emergency or crisis situation.

Consultations with counselors can happen in person, over the phone or via email. During consultation, a professional counselor will provide education and support to help the concerned others know what to do/say to their student in distress, and help them identify resources. At the counselors' discretion, the counselor may contact the student of concern to offer services and, ideally, schedule an appointment for an intake and evaluation regarding suicidal ideation. In keeping with best practices, counselors log notes and contacts in a secure database and may bring cases to colleagues for professional consultation.

Strategies for a Referral to Counseling

  • Walk Student to the Counseling Center
    When possible, a phone call to Counseling (775-673-7060) should precede this action in order to notify the office and allow them to prepare to see and evaluate the student. If your concern is after hours, the Crisis Call Center at 800-273-8255 will walk you through helping the student or talk to the student directly.
  • Call the Counseling Center and Consult Regarding What Action to Take (either immediate or in the future)
    When immediate action is anticipated, phone contact is best made openly, in the student’s presence and with his/her consent. Call with any concerns. Your intuition is most likely correct and there probably is a problem.

Students cannot be mandated to receive a counseling intervention based only on the perception that the student is in distress or has a mental illness.

The goals in working with a distressed student are to facilitate evaluation, to stabilize the emotional distress, and to provide support and tools to keep the student safe and out of the hospital.

Training

TMCC's Counseling Center provides training to recognize and intervene with a person at risk of suicide. Trainings include awareness workshops such as SafeTALK and SuicideTALK as well as more in-depth classes such as Mental Health First Aid and ASIST. All trainings are provided to members of the campus community at minimal, or in most cases, no cost.

Collaborative Assessment and Management of Suicidality (CAMS)

The TMCC Counseling Center has adopted the Collaborative Assessment and Management of Suicidality (CAMS) as our protocol for the management of students with suicidal ideation. CAMS is a suicide-specific, collaborative framework for providing care to individuals at risk of suicide.

The framework emphasizes five core components of care over 10-12 sessions/3 months:

Component I. Component II. Component III. Component IV. Component V.
Collaborative Assessment of Suicidal Risk Collaborative Treatment Planning
  • Attend counseling sessions reliably as scheduled over the next three months 
  • Reduce access to lethal means 
  • Develop and use a Coping Card as part of Crisis Response Plan 
  • Create interpersonal supports
Collaborative Deconstruction of Suicidogenic Problems
  • Relationship issues (especially family) 
  • Vocational issues (what do they do?) 
  • Self-related issues (self-worth/self-esteem)
  • Pain and suffering (general and specific)
Collaborative Problem-Focused Interventions Collaborative Development of Reasons for Living
  • Develop plans, goals, and hope for the future 
  • Develop guiding beliefs 

Counselors will also address concerns about students who are resistant or reluctant to accept a referral to counseling by acting as a liaison for the student to receive follow-up academic planning or other services. There may be times when a student’s distress is acute enough that he or she needs to withdraw from school. Counselors help students to navigate through the processes of withdrawing from school and returning from a leave in relation to a mental health concern.

Student Conduct Office

If a distressed student refuses contact with the Counseling Center and is behaving in a manner disruptive to the campus learning environment, a Student Conduct Complaint may be filed.

The Student Conduct Officer will evaluate the situation and determine the best course of action. If there is concern that the student could present a danger, the Student Conduct Officer consults with the Threat Assessment Team (TAT) to evaluate the threat and to coordinate intervention and post-intervention strategies involving key individuals.

The Symplicity Advocate Public Incident Report form is also available to anyone who is concerned for another person and is not comfortable with a direct intervention. If the behavior does not meet criteria for an emergency response, individuals may utilize the Symplicity Advocate Public Incident Report form to file an incident report electronically.

Threat Assessment Team (TAT)

The Threat Assessment Team (TAT) is a multi-disciplinary team whose mission is to provide a proactive, coordinated, and planned approach to the identification, assessment, management, and where possible, the reduction and/or prevention of behavior that falls into defined classification categories.

The team is available to review and discuss students, employees or other persons who have raised concerns and may be a risk of harming either themselves or others, or who pose a significant disruption to the learning, living or working environment. Although it may not be possible for the Counseling Center to release confidential client information to the TAT, the counselors notify the TAT of situations that involve the potential to harm other students or campus personnel.

The TAT is chaired by the Student Conduct Officer, who determines which cases are brought for review by the TAT. Concerns are brought to the Student Conduct Office in a variety of ways: through incident reports (including those filed electronically), police actions, or concerns raised by members of the TAT. It is always better to err on the side of caution and report a suspicious incident.


When Uncertain Whether it is an Emergency

Stay calm and assess the situation objectively and rationally. The person in crisis will be feeling anxious and uncertain and may lose perspective of the situation.

If you are reflecting on a situation that happened with a student and need input, please call the Counseling Center. It is not always an immediate recognition with the non-emergency situations, but putting the pieces together later may inspire you to reach out.

If there are questions, call the TMCC Counseling Center (775-673-7060) for support for the person, and for yourself.

Privacy

Be aware of the person’s right to privacy. When possible, choose a time and location when you are able to talk to the person without disruption and in private setting. Do not promise confidentiality to the person if their life is in danger.

Communication

Communicate with the individual; this may include:

  • Asking the person what may be going on. The act of just asking may be helpful as it is showing a sense of concern and empathy.
  • Listening to the person, allow them to talk and truly listen to them. This may be done by focusing on what the person is saying.
  • Allowing the time for them to express what they are feeling without judgement. Do not rush them, give them this time to allow them to identify their feelings, such as loss, pain, sadness, anger and hopelessness. 
  • Using active listening by using "I" statements, such as, "I hear you saying that..." which lets the person see that you are listening and you care.

What to Say

If you believe the person is at risk for self-harm and you do not feel comfortable addressing the concern directly, tell the student you are concerned and you want to help him/her get the assistance they need by connecting them to someone with more expertise.

  • TMCC Counseling Center: 775-673-7060
  • Crisis Call Center: 800-273-8255

You can say something like the following: "I can call the Counseling Center (or the Crisis Call Center) for you, or you can make the call yourself, what would you prefer?", or you can offer to walk the student to the TMCC Counseling Center.

If the student chooses to make the call, say: "I’m glad you are doing this. Here is the number, I’ll wait right here in case you need me."

If you believe the student is at risk for self-harm, and you feel comfortable probing, ask directly the following questions (note: You want to ask these questions, but be sensitive and open to exploring each. It should not be an interrogation):

  • "Are you thinking of suicide?"
  • If yes, follow with: "It sounds like you are in great pain, what is going on?"
  • "Do you have a plan?"
  • "Do you have the means to carry out the plan?"
  • "Have you tried suicide before?"

Identify Student Resources

If the student is not in immediate danger, offer to help him/her identify resources:

  • Provide the individual with the crisis call center number: 1-800-273-TALK (8255).
  • See TMCC Counseling Center Resources and Referrals.
  • Ask the student what resources he/she may need to alleviate their distress. Focus on the person’s personal supports and their willingness to get the help needed to feel better. If possible, write down the student’s plan so he/she can share it with the counselor.
  • Walk the student over to the Counseling Center for an appointment or call the Counseling Center at 775-673-7060.
  • Follow up with the student to help ensure care was sought and provided.

Assisting International Students

When counseling international students in acute and/or suicidal distress, cultural differences need to be taken into consideration. Recommendations for identifying, approaching, and providing successful assistance to international students include but are not limited to:

  • Developing an understanding of cross-cultural resources and awareness of intercultural communication styles by enhancing or expanding training offered. Being aware and examine your own stereotypes and bias. It is crucial that counselors develop cultural competency skills in order to best serve international students.
  • Knowing federal regulations pertaining to international students and scholars when responding to a crisis. When in crisis, students may not be able to attend classes, and this can impact their immigration status if the appropriate documentation is not submitted.
  • Utilize the Northern Nevada International Center, Language Bank which can provide language interpreters. Interpreters can be consulted when necessary.

Suicide Attempt in Progress

The nature of a suicide attempt varies, but in each scenario it should be taken seriously as a threat to life.

In all cases, discretion should be taken to protect the person’s privacy, while also providing assistance immediately. Confidentiality does not apply in a situation in which a person’s life is in danger.

  1. Call University Police Services: 775-334-2677 and call 911 (since University Police Services are on campus, they may be able to respond more quickly).
  2. Provide first aid if necessary. 
  3. Police will transport the person to the emergency room and will notify the TMCC Counseling Center of the situation.
  4. Follow protocol for notifying emergency contact.
  5. The Counseling Center will designate a counselor to follow-up with the student and will offer services to those impacted by the suicide attempt.

Attempted Suicide Off-Campus

Persons who are aware of an off-campus suicide attempt by a TMCC student are strongly encouraged to notify the TMCC Counseling Center, the Student Conduct Office/University Police Services, or to complete an electronic incident report.

The TMCC Counseling Center, or designee, will contact the student to initiate intervention and/or follow-up services as needed (and to ensure that a release of information is obtained by all agencies involved). The TMCC Counseling Center will provide referral services to the friends and family of the person and counseling and training to members of the TMCC community (students, faculty and staff) that have been impacted.


Student Death

In a crisis, where a person’s life is at stake, the primary goal is to save the person's life.

If able to, the non-injured person should render first aid and/or call emergency medical assistance by dialing 911 and/or University Police Services (775-334-2677). Be aware of your exact location to assist medical and emergency personnel of finding you.

If the person is deceased, do not disturb the scene. If possible, secure and exit the scene while ensuring that it is not disturbed until medical or police arrive. If there are two people, one should stay at the scene while the other calls 911 and the University Police Services.

Discretion

Death can be traumatic for all people in the campus community. Until there is an official cause of death, labeling the death as a suicide or homicide may further complicate the matter.

Discretion must be used by the witnesses of an event regarding what is shared to non-emergency personnel.

Notification to the primary supports (i.e., family, friends and faculty) will be accomplished with discretion to protect the privacy of those directly involved. The Counseling Center will provide referral services to the friends and family of the person and counseling and training to members of the TMCC community (students, faculty and staff) who may have been impacted.

Notification of Emergency Contact

It is crucial that students maintain updated Emergency Contact Information. TMCC's Admissions and Records Office reminds students to update their emergency contact each semester at registration. In addition, advisors and counselors encourage students to update their information when they advise or counsel students.

In the case of student death: Notification will be accomplished by the coroner or the police department. A member of the campus administration will assist with the notification of on-campus death.

In the case of an emergency: A University Police Services officer trained in crisis intervention, or a counselor, will notify the emergency contact when a student is acutely distressed or suicidal. Only essential information will be revealed without the student’s informed consent.

For international students: Where language may be a barrier, translators will be secured to interpret for the emergency contact. The Northern Nevada International Center provides translation services in multiple languages and should be utilized when necessary to assist with notification to emergency contacts.

If you are first on the scene of a death, it can be traumatic and seeking help for yourself (even months later) is important. Counselors will be provided to facilitate grief processing to any person who is affected by the death.


Post-Crisis Follow Up

TMCC Counseling Center Responsibilities

The Counseling Center Director or counselor on-call will be notified of on and off-campus events and log the information into the secure counseling database. The Counseling Center Director, or designee, will follow-up with law enforcement, mental health facilities, emergency rooms, and other involved agencies to ensure TMCC Counseling Center services are included in post-crisis care when appropriate.

The Counseling Center Director will assign a counselor to facilitate follow-up planning when a student returns to school following hospital referral for mental health concerns. Follow-up planning will include:

  • A review of the academic impact of recommended interventions,
  • Identification of campus resources and support services that may be of assistance to the student.
  • Use of the CAMS protocol if appropriate.

The counselor will advise the student of their options and help facilitate the student’s decisions about their aftercare. Primary follow-up concerns include arranging mental health aftercare and coordinating needed support and assistance to help the student make up missed work, as well as identify any needed academic, financial, or social supports. It is ultimately up to the student to determine what services and planning he/she wishes to access.

In some situations, mental health problems are associated with behaviors that can pose a risk of danger or disruption to others. Behavioral problems will be addressed, as appropriate through the campus student conduct office and/or the Threat Assessment Team.

Academic Options for Leave

Circumstances reasonably beyond the control of the student, which causes the student to be unable to attend classes, complete the semester, or otherwise become academically delinquent, may be a consideration for several academic options.

Several factors should be considered in the decision-making process. The student and counselor will review assessment and recommendations, student’s academic progress, and GPA. The student’s perspective and understanding of the problem, and timely reintegration will be addressed.

Documentation to substantiate the student’s claim requesting leave is required.

Requests are to be made in a timely fashion, when it first becomes evident that circumstances prevent a student from performing academically. Such circumstances include:

  • An incapacitating illness or injury (e.g., psychological, medical) that prevents the student from returning to school for the remainder of the semester. 
  • Death of the student’s spouse, child, parent or legal guardian.
  • Other exceptional circumstances beyond the student’s control.

Incomplete

A temporary grade of incomplete (I) may be granted to a student at the end of the semester if the student is performing passing work in the course, and there are extenuating circumstances (beyond the student’s control) that prevent the student from completing the course requirements by the end of the instructional period.

Audit

A student who wishes to enroll for no credit may register as an auditor.

Withdrawal after the Drop Date

Students who wish to withdraw from a course(s) during the semester, and are no longer eligible for refunds based on TMCC withdrawal policy, can appeal the process.

Students considering a complete withdrawal from all classes are strongly encouraged to contact the Financial Aid Office before withdrawing.

Suspension or Expulsion

The administrator and faculty working with the student to successfully address a student conduct incident (such as: the student having made a threat to harm others) will collaborate with counselors, the student, his/her parents, academic advisor, and others (as appropriate for the given circumstances) to resolve the conduct concern while addressing the mental health needs of the student.

Students suspended or expelled will be treated as described according to NSHE policies and procedures. Any opportunity to withdraw from courses afforded to students through the institution’s policy will be provided to a student.

The decision-making criterion for placing a student on suspension or expulsion involves consideration of the distressed student’s behavior is causing to others in the campus community. If the student’s conduct is significantly disrupting the lives of others on the campus (as with misconduct in the classroom or other venues), and other measures to resolve the conduct problem have failed, then a suspension or expulsion may be necessary.

Academic Options for International Students

International students (F-1 and J-1 Visas) are required to be enrolled in a minimum of 12 credits during the Fall and Spring Semesters.