Mental Health

Students experience distress when their stress level exceeds their coping resources, which can easily happen in an unfamiliar environment, such as a study abroad host country. Emotional distress can have a profound impact on students' academic progress, personal relationships, and enjoyment of their experiences abroad. The ability to recognize signs of serious emotional distress and the courage to acknowledge concerns directly are often later noted by students as the most significant factor in their problem resolution. Use the following checklist when monitoring your and your peers' mental health while studying abroad.

Signs of Distress Checklist

Assessment/Referrals


Signs of Distress Checklist

Behavioral Changes:

  • Decline in the quality of work, assignments not completed
  • Frequent absences from class
  • Inability to sit through classes
  • Disruptive behavior in classes
  • Repeated requests for special accommodations such as extensions or postponed examinations
  • Turning in coursework that has suicidal or homicidal themes
  • Impaired speech or thought patterns

Physical Changes:

  • Marked change in physical appearance and personal hygiene
  • Dramatic weight gain or loss
  • Chronic tiredness, headaches, gastrointestinal problems without a medical explanation
  • Change in sleep patterns: insomnia, sleeping too much, not needing sleep
  • Disordered eating: restricting, binging, purging, over-exercise
  • Panic attacks; overwhelming anxiety

Personality Changes:

  • Extreme sadness and tearfulness
  • Severe depression
  • Irritability
  • Hostility
  • Marked anxiety
  • Outbursts of anger
  • Withdrawn
  • Hyperactive
  • Excessive dependency on others
  • Mood swings
  • Confusion, indecisiveness
  • Much more talkative than usual, sentences are tangential or incoherent

Safety Risk Changes:

  • Expressions of hopelessness, powerlessness, or worthlessness
  • Verbal statements or notes that have a suicidal or homicidal tone to them
  • Expressions of concerns about death or life after death
  • Giving away important possessions
  • Self-injurious or self-destructive behaviors
  • Violent threats against others
  • Out of control behavior

Other Risk Factors:

  • Inability to adjust or inappropriate reactions to local cultural norms
  • Secretive about experiencing severe emotional distress
  • Poor self esteem; extreme difficulty in working out own identity
  • Lack of close, supportive friends, or family ties
  • Increased isolation
  • Death of a close friend or family member
  • Sexual assault; sexual harassment
  • Break-up of a relationship
  • Poor academic performance
  • Intense academic pressures
  • Serious illness
  • Substance abuse issues
  • Poor problem solving and coping skills

Assessment/Referrals

If you are experiencing any of these changes, talk to your program director or, if you prefer, a medical professional. If you notice these changes in a friend or peer overseas, you can assist by acknowledging with care that you are concerned about this person's welfare, and if you deem it appropriate, by referring this person to a health professional. Other steps to take when assessing your own mental health or that of others can be found below.

  • Establish a climate of trust and safety, gather information, & explore possible solutions
  • Be friendly without being a "friend" -- maintain a professional relationship and establish clear and consistent boundaries. Show interest and support.
  • Ask to see the student in private to minimize embarrassment and defensiveness.
  • Acknowledge with care that you are concerned about the student's welfare.
  • Use constructive self-disclosure to acknowledge your observations of the student's situation and express your concern directly and honestly. Strange or inappropriate behavior should not be ignored. Comment directly on what you have observed with non-judgmental descriptions.
  • Listen respectfully and provide empathy without necessarily agreeing or disagreeing with the student's point of view. Try not to minimize his/her pain. Try to refrain from making quick judgments.
  • Ask follow-up questions for better clarification and understanding. Demonstrate that you understand what the student is disclosing by paraphrasing what the student has told you.
  • Assist the student in identifying several options and a plan for action. Review past coping strategies. Explore the possible consequences of the student's action and non-action. Develop a backup plan.
  • Keep the lines of communication open. Arrange time to follow-up with the student.

Suggestions for making referrals

  • State clearly why you believe a referral would be helpful.
  • Be open to listening to any concerns or fears that the student might have about seeking help.
  • Try to normalize seeking help by conveying that everyone has problems at times that require assistance.
  • Communicate that you view seeking help as a sign of courage instead of a sign of weakness.
  • Demonstrate that you are hopeful that change is possible.
  • Learn about available referral resources so that you can provide specific and appropriate information. Have a list readily available that includes the names, phone numbers, and locations of referral sources.
  • Encourage the student to take responsibility for whether he/she will seek assistance.

Information adapted from the SAFETI Online Newsletter, Vol. 3, #1, 2005.