Make a Difference: Tips for Teaching Students who have Psychiatric Disabilities Handbook Karen Northup, M.A., Outreach Specialist, Project PACE Susan Queller, M.Ed., Director Disability Support Services Melanie Thornton, M.S., Director, Project PACE Sarah Woodyard, Office Manager, Project PACE U.A.L.R. University of Arkansas at Little Rock, Little Rock, Arkansas Acknowledgements Handbook Lead Writers: Karen Northup & Sarah Woodyard Editors: Melanie Thornton, Susan Queller, & Roberta Sick Layout/Transcription: Sarah Woodyard We are grateful to Sharon Downs, Project Coordinator of the Arkansas State Outreach and Technical Assistance Center (SOTAC) at UALR for the concept and format of this handbook. Portions of this handbook were adapted from previous publications of UALR Disability Support Services and Project PACE. We extend our thanks to the following authors of those publications for their contribution and permission to utilize their work so that we may provide continuity throughout this series-Jan Chaparro, Joanne Benica, Katy Evans, Sharon Downs, and Heidi (Lefebure) Scher. Video This guide was developed to accompany the video of the same name. The video is also a product of Project PACE. The staff members of Project PACE are grateful to the UALR School of Mass Communications for their production expertise with a special thanks to David Weekley. We also are grateful to our narrator, Pamela Smith, and to the numerous individuals who shared their time and experiences with us by providing interviews for this video. Video Production Executive Producer: Melanie Thornton - Director, UALR Project PACE Producer/Director/Editor: David Weekley - Instructor, UALR School of Mass Communications Field Production Assistants: Sarah Woodyard & Katy Evans Captioning: Michael Merritt Video Script: Melanie Thornton & Katy Evans Narrator & Video Interviews (in order of appearance) Pamela Smith, News Anchor Tina Wagoner, Former Student, University of Arkansas at Little Rock Seshe Brewer, Student, University of Arkansas at Pine Bluff Courtney Pruitt, Student, University of Arkansas at Fort Smith Mark Sullivan, Non-traditional Student Patrick Gray, Disabled Veteran Leah Landis, Student, Arkansas State University References Consensus Report. (2005). About the Problem: Factsheet. A consensus project coordinated by the State Government Councils. Retrieved September 15, 2004 from www.consensusproject.org/topics/factsheets/factsheet. National Institute of Mental Health. (2005). Statistics. Retrieved on September 15, 2004 from www.nimh.nih.gov/healthinformation/statisticsmenu.cfm. Special Thanks To: NAMI - Arkansas Roberta Sick, Partners for Inclusive Communities Project PACE is funded through a grant from the U.S. Department of Education, Office of Postsecondary Education, #CFDA P333A990056. Project PACE offers training and resources to assist postsecondary level faculty in providing a quality education to students with disabilities. This handbook and the video it accompanies are two of the many activities funded through this grant. For more information about Project PACE and other resources available, contact us at: Project PACE, University of Arkansas at Little Rock, Stabler Hall #104, 2801 S. University Avenue, Little Rock, Arkansas 72204, (501) 569-8410 (voice/TDD), (501) 569-8240 (fax) www.ualr.edu/pace or UALR Disability Support Services, (501) 569-3143 (voice/TDD), www.ualr.edu/dssdept. Published 2005 Table of Contents Introduction - 1 Instructions for the In-service Presenter - 2 An Overview of Psychiatric Disabilities - 3-4 Implications of Psychiatric Disabilities in the Postsecondary Education Setting - 5-6 Considerations for Preparation During the Semester - 7-8 Considerations for Instruction During the Semester - 9-10 Guidelines for Administering Exams - 10 Appendix A: The Range of Psychiatric Disabilities - 11 Appendix B: Information on Current Medications Used for Psychiatric Disabilities - 11-13 Appendix C: Additional Resources About Psychiatric Disabilities - 15-16 Appendix D: Video Script - 17-22 References - 23 (page 1) Introduction This handbook was written to accompany the video also entitled Make a Difference: Tips for Teaching Students with Psychiatric Disabilities. Through utilization of these resources we hope instructors will: Achieve a better understanding of the impact of psychiatric disabilities Improve interactions with students who have psychiatric disabilities Increase awareness of various types and implications of psychiatric disabilities Increase awareness of possible preparations and accommodations Learn effective strategies for teaching students with psychiatric disabilities Learn how to make course materials more accessible This resource is not intended to replace consultation with service providers. Most postsecondary institutions have an office or individual on campus to assist faculty and staff in making accommodations for and working with students with disabilities. If you need assistance in accommodating a specific student, contact your administration or the disability services office to ask about the procedures for your campus. (page 2) Instructions for the In-Service Presenter If you are showing this video as a part of a workshop, you may want to consider pausing or stopping the video for group discussion. If you need additional copies of this handbook or the video, contact Project PACE or Disability Support Services at the University of Arkansas at Little Rock at (501) 569-8410 (voice/TTY) or (501) 569-3143 (voice/TTY). This video and handbook are the fourth in a series. The first video/handbook set in this series is Make a Difference: Tips for Teaching Students who are Deaf or Hard of Hearing and can be ordered through the PEPNet website (www.pepnet.org). The second and third video/handbook in this series Make a Difference: Tips for Teaching Students who are Blind or Have Low Vision and Make a Difference: Tips for Teaching Students who have Learning Disabilities can be ordered by contacting Project PACE. The complete CD video/handbook set is now available for purchase. An order form is available on the Project PACE website (www.ualr.edu/pace). (page 3) Overview of Psychiatric Disabilities What is a Psychiatric Illness? A psychiatric illness is a biologically-based brain disorder. These disorders can affect a person's thinking, ability to concentrate, functioning capabilities and emotions. Keep in mind that the terms "mental illness," "psychiatric disorder" and "psychological disability" are often used interchangeably when referring to this particular disability. It is also important to realize that a psychiatric illness, though not physically apparent, is as real as a more obvious disability, such as paralysis, blindness or deafness. It is not an illness that is caused or cured by will power or intelligence but one that may be treated and stabilized with medication and support systems. Psychiatric illnesses may be diagnosed as mild to severe and may include the following: Major depression Bipolar disorder Anxiety disorder Obsessive-compulsive disorder Schizophrenia To learn more about these specific psychiatric disabilities, see Appendix A. A psychiatric illness is considered a disability when it results in a substantial limitation to performing a major life activity. According to the National Alliance of the Mentally Ill (NAMI), the most serious and disabling conditions affect five to ten million adults and three to five million children ages five to seventeen in the United States (NAMI, 2005). Individuals are commonly diagnosed with a mental illness during the developmental stages, including the teenage years and young adulthood. There is no specific type of person who may be diagnosed with a mental illness. A diagnosis can happen at any time to anyone but manifests more often in those who are young or who are elderly. (page 4) There are many effective treatments available today for persons with psychiatric disabilities. "Between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and support systems" (NAMI, 2005). Support systems may include the family, co-workers, and the educational environment, provided there are on-campus resources, such as a disability support services office. With the appropriate treatments and support, stabilization may be accelerated. Each aspect of treatment is vital to the success of a person with a psychiatric disability. Language Many people are concerned that they may offend a person with a disability by using the wrong language. Here are some tips that may be helpful to you. When referring to a person with a disability, put the person first. That is, speak of "a student with a mental illness" or "people with disabilities" not a "mentally ill student" or "disabled person." Also, remember to use the term "disability" instead of the term "handicapped." Terms such as "crazy," "insane," "deranged," or "not normal" are inappropriate and stigmatizing. The word "disorder" is a clinical term used commonly in the medical and psychiatric field. Though it is acceptable in the clinical setting, terms such as "disability" or "illness" are generally recommended in other settings. Keep in mind that you may hear people with mental illnesses use this and/or other terminology to refer to their own illness. Be aware of which term the student is most comfortable using and follow his or her lead. (page 5) Implications of Psychiatric Disabilities in the Postsecondary Education Setting Psychiatric illnesses can affect individuals of any age, gender, and intellectual group. The onset of these illnesses can occur at any developmental period, but the onset of many types of psychiatric illnesses most commonly occurs between the ages of 18 and 25. This is of critical importance to those working in postsecondary education settings since at most institutions the majority of students fall within this age range. Increasing numbers of students with psychiatric disabilities are pursuing postsecondary education. The National Center for Educational Statistics (1999) reported that more than 30,000 students enrolled in postsecondary institutions report having a mental illness. A psychiatric disability plays a significant role in the life of a student, affecting a person's modes of thinking, emotions, relationships, and ability to cope with stressors. These students are intelligent and capable of pursuing and succeeding in higher education once barriers to equal access are removed. Many times psychiatric disabilities go unnoticed, even to the person who is experiencing the symptoms. Those who are not diagnosed or not appropriately treated or accommodated for psychiatric disabilities are at higher risk for experiencing: Unemployment Substance abuse Homelessness Inappropriate incarceration In addition, those individuals with a mental illness who are students may experience symptoms that interfere with educational goals. These symptoms may include, but are not limited to: Increased anxieties Confusion or disorganized thinking Difficulty concentrating, making decisions, or remembering things Restlessness and shortened attention span Highs and lows in mood (page 6) It also may be helpful to keep the following in mind: The student's symptoms may vary during the semester. A student's need for accommodations may be sporadic. The student may not, for example, request accommodations at the beginning of the semester, but mid-semester may have symptoms that require a request for accommodations. This fluctuation of symptoms is a normal part of any chronic illness and should not be interpreted as malingering. The student may have to miss classes occasionally or may have an extended absence. A flexible attendance policy could help to lower the stress and anxiety felt by the student participating in your course. The student may have symptoms that directly affect his or her ability to perform academically. Symptoms that may have a direct impact on learning include: difficulty concentrating, fatigue, memory and recall problems, and drowsiness. These symptoms can be caused by the disability or may be side effects of medications. Psychiatric disabilities are "hidden" disabilities. Psychiatric disabilities have long carried a certain stigma. These disabilities are often misunderstood or perceived in a negative light. Students with these disabilities sometimes express concerns that they will be treated differently or discriminated against once their disability is revealed. These students, therefore, may not request accommodations that would allow them to perform at their full potential. Disruptive behavior is not a defining characteristic of most people with psychiatric disabilities. Responding to student behavior in a manner consistent with classroom and institutional policy is important whether it is a student with or without a disability. Not every student who has a psychiatric disability is disruptive. The converse is also true: not every student who is disruptive has a psychiatric disability. (page 7) Initial Preparations for the Semester Students who have been diagnosed with a psychiatric disability are just as intelligent, sensitive, creative, and interesting as other students in your class. By creating an environment that is universally designed to promote success, everyone benefits. It is common for some professors to experience anxiety when they first learn that a student with a psychiatric disability is taking their course. Increasing one's awareness of the impact of a disability and the accommodations that may be needed can help to reduce such feelings of anxiety. Included here are some tips that could make the process go more smoothly. Many faculty members have found that by implementing these tips and strategies, also known as "Universal Design," all students - not just those with a disability - benefit. Announce in class that you are available to discuss modifications with any students who need accommodations for a disability. Making yourself available to all students is an invitation for the student to approach you. Never single out students in class. Also be sure to have a disability statement in your syllabus about the availability of accommodations. Work closely with the student to develop accommodation strategies or to implement those outlined by the disability service provider on your campus. Some students with a diagnosed psychiatric disability are not aware that they may qualify for services with the on-campus disability service providers. If a student approaches you and discloses to you that he or she has a mental illness, it may be helpful to inform the student about academic support services including disability services. Clearly define behavioral expectations for all students in your class. By having an expectation for all students you are not singling out any individual student. Prepare the course syllabus, assignment list, due dates, and reading list early so they are available should they be requested before the semester begins. The student may need to prepare for the upcoming semester to help (page 8) reduce anxiety about the course. Some students may have difficulty with time pressures and managing multiple tasks. The opportunity to plan ahead will be extremely beneficial to these students. Avoid making major changes to the syllabus and course requirements once the student has received the information. Some students do not respond well to changes made and have difficulty with unexpected requirements of a course. For example, changes in due dates, assignments, and even instructors may be difficult for the student. Address a variety of learning styles (e.g., auditory, visual, kinesthetic, or experiential). Provide examples of good projects or research papers from previous years. Most students will be honored to give you consent to use their assignments as successful models for fellow students. Provide study questions or practice exams that familiarize students with the format and the content of the test. Provide an example of a good response and explain why it is acceptable. Do not change the format of the exam from the examples provided in class. Some students with a psychiatric disability have severe test anxiety to a point that they are emotionally and physically unable to take an exam. Allow time for an early draft of a paper or project to be turned in for feedback. If students know that they have time to turn in assignments and obtain feedback they are likely to experience less anxiety over the work. Keep in mind that some students may have a difficult time understanding and accepting criticism or poor grades and may respond defensively to negative feedback. Plan for breaks in the class period. Some students experience restlessness or have a shortened attention span. Having a break or an activity that allows the student to switch gears for a moment may help with the overall retention of material presented in class. (page 9) Considerations for Instruction During the Semester Assist in finding notetakers. Notetaking may be difficult due to concentration difficulties or difficulties in organizing the material quickly enough to get down the important points. Provide copies of overheads or PowerPoint slides, either on paper or electronically. Allow tape recording of lectures. Access to these tapes after class will help the student get more benefit out of lectures during times when concentration is compromised or when the student is drowsy from medications. Consider providing copies of your class notes. Some faculty prefer to post these on a website for all students. Support modifications in seating arrangements. Seating location in the classroom can have an impact on ability to focus and concentrate. Allow beverages in class and/or tolerate the student leaving the classroom for breaks. Some medication regimes cause extreme thirst as a side effect. Offer alternative ways of completing assignments. For example, a student with severe anxiety may perform better doing a written assignment or a pre-recorded presentation versus an oral presentation. In doing so, do not lower your standards, just consider other ways that the course objectives might be met. Allow for periodic appointments outside of class to discuss progress or provide support and feedback. A symptom of some psychiatric illnesses is extreme self-doubt, while other illnesses may result in an inflated self-esteem. Meeting with the student regularly to give the student a realistic picture of his or her progress in your class may help the student stay on track. (page 10) Provide flexibility in attendance policies. Some instructors provide points for attendance. This approach may result in a lower grade for a student with a disability. Consider alternative ways for giving credit for participation, or increase the number of absences permitted before the grade is affected. Allow the student to take an "incomplete" or grant a late withdrawal rather than failure in case of prolonged absences due to severe symptoms or hospitalization. Such cases may need to be reviewed or discussed with staff in your disability services office. Guidelines for Preparing and Administering Exams Provide extended time (double time is standard). Allow the student to have access to you during the test. Since the ability to concentrate may be compromised by either the illness or the medications, extended time may be an appropriate accommodation. Provide low distraction rooms to take exams. Being easily distracted is a symptom of some psychiatric disabilities. Taking a test in an environment with fewer distractions may improve performance. Remember that the same accommodations apply to pop quizzes or other in-class assignments as to full-length exams. Students should be scheduled to complete quizzes either the same day or as close as possible to the same day. A possible solution for quizzes when a low distraction room is not an accommodation would be to have the student start in class and finish after class. For in-class assignments consider giving the student until later that day or the next day. Discuss these issues in your initial meeting with the student. (page 11) Appendix A: The Range of Psychiatric Disabilities To help you increase your awareness and understanding, some of the more commonly diagnosed psychiatric disabilities are explained below. Anxiety Disorder: This can be diagnosed as either a generalized anxiety disorder or a panic disorder. Symptoms can include changes in sleep patterns, rapid heart rate, dizziness and fainting, tremors, tension, and general uneasiness. People with anxiety disorders often seem to be unable to relax. They may focus on mistakes, worries, regrets, or potential future problems. Bipolar Disorder: This illness is characterized by episodes of mania and depression. It is also often called manic-depressive disorder. In the manic phase, individuals may experience an inflated self-esteem, a decreased need to sleep, irritability, grandiose notions, poor judgment, inappropriate social behavior, and disconnected, racing thoughts. In the depressive phase, individuals may experience any of the characteristics associated with a diagnosis of depression. Major Depression: Some characteristics of major depression are a persistent sad or anxious mood, feelings of sadness, inactivity, difficulty with thinking and concentration, thoughts of suicide, insomnia, feelings of worthlessness, feelings of guilt, an increase or decrease in appetite, and persistent physical symptoms such as headaches and nausea. Obsessive-Compulsive Disorder: Individuals with this disability engage in recurrent unwanted thoughts or behavior. They cannot control their behavior despite recognizing that the behavior is unusual, unhealthy, or irrational. Individuals may not always act out obsessive thoughts but the thoughts disturb them and interfere with functioning in daily life. Compulsive behavior is repetitive and ritualistic in nature, and although perceived as unusual, seems purposeful. (page 12) Schizophrenia: Schizophrenia is a chronic brain disorder characterized by extreme distortions of reality and a loss of contact with the environment. Individuals may experience hallucinations, delusions, withdrawal, and loss of self-control. A diagnosis of schizophrenia is very serious and ultimately can affect all functional areas of an individual's life. However, new findings about the nature of this illness and successful treatment regimes have greatly improved the outlook for people with schizophrenia. (page 13) Appendix B: Understanding Medications and Their Side Effects In many cases, the side effects of medications taken for a mental illness may have as much of an impact on the learning process as the illness does. Listed below are general medication categories and the side effects that most influence the student in an educational setting. This list is provided to increase awareness of the fact that accommodations suggested have a direct connection to these side effects. Take the effects of these medications into consideration when planning your classroom environment and providing accommodations to your students. Antidepressant Medications: These medications are most commonly prescribed to treat major depression. Antidepressants are given to bring balance to a chemical imbalance that can be brought on by a combination of physiological factors and life experiences. Some of the most common antidepressants prescribed are Zoloft, Wellbutrin, Paxil, and Prozac. Each of these medications affects an individual differently but many of the side effects are similar. Possible side effects: Dry mouth Anxiety or nervousness Dizziness Headaches Drowsiness or insomnia Blurred vision Antimanic Medications: Antimanic medications are most commonly used to help persons who have been diagnosed with bipolar disorder. The most common medication used to treat this illness is lithium. This medication is used to level out mood swings in both the manic and depressive states. The side effects of antimanic medications may have a significant affect on students in the learning process. (page 14) Possible side effects: Weakness and fatigue Drowsiness Hand tremors Extreme thirst and increased need to use the restroom Antianxiety Medications: Antianxiety medications are used to combat symptoms of severe anxiety such as breathing problems, faintness, irregular heartbeat, etc. Medications that doctors prescribe to treat these disorders are Effexor, Paxil, Prozac, Luvox, and many more. While the side effects are few, each one can dramatically impact the success of a student in the educational environment if accommodations are not provided. Possible side effects: Drowsiness Loss of coordination Less frequently occurring: Fatigue Mental slowing or confusion Antipsychotic Medications: Antipsychotic medications are used to combat the symptoms present in a person who experiences behaviors caused by a lack of communication between neurotransmitters (nerve cells) within the brain. Some examples of these medications are Risperdal, Clozaril, Zyprexa, and Geodon. Each of these medications may cause varying side effects that affect students in an educational setting. Possible side effects: Sleepiness Dizziness Restlessness Feeling unusually tired Tardive Dyskinesia (involuntary movements of the mouth, limbs or body, typically occurring only with long-term usage of this class of medications) (page 15) Appendix C: Resources for Additional Information on Psychiatric Disabilities American Academy of Child and Adolescent Psychiatry Information is provided as a public service to aid in the understanding and treatment of the developmental, behavioral, and mental disorders. www.aacap.org American Psychological Association Information and links to a number of psychology-related topics. www.apa.org Center for Psychiatric Rehabilitation, How-to Tips for Educators Practical information about reasonable accommodations for people who have psychiatric disabilities. www.bu.edu/cpr/reasaccom/index.html Mental Health Information Source Source for mental health and medical continuing education. www.mhsource.com National Alliance for the Mentally Ill (NAMI) Support and advocacy organization of consumers, families, and friends of people with severe mental illnesses. Award-winning Web site. www.nami.org National Institute of Mental Health (NIMH) General information on mental health-related issues, news, facts, and statistics (available in Spanish). www.nimh.nih.gov National Mental Health Association The country's oldest and largest nonprofit organization addressing all aspects of mental health and mental illness through advocacy, education, research and service. www.nmha.org (page 16) Appendix D: Video Script Make a Difference: Tips for Teaching Students Who Have Psychiatric Disabilities [Music opener] Pamela Smith (Narrator): Hello, I'm Pamela Smith for Project PACE. Approximately one in five adults in America has a diagnosable mental illness. Still, students with this disability continue to be among the most misunderstood of our student population. Because of the misconceptions that surround psychiatric disabilities, many of these students fear being ostracized and therefore do not request accommodations that would benefit them. We hope to provide some facts and personal stories that will counteract these misunderstandings and increase awareness of the implications of a psychiatric disability in the postsecondary setting. In this presentation, the terms mental illness and psychiatric disability will be used interchangeably to refer to a group of illnesses that result from biologically-based differences in the brain and the brain's chemistry. Among the conditions included in this category of disabilities are depression, bipolar disorder, schizophrenia, anxiety disorders, post-traumatic stress, and obsessive-compulsive disorder. Courtney Pruitt: I think that a lot people including faculty have misconceptions that students who have a disability with a mental illness can't survive in normal society, that we can't go to school, that we don't live in apartments by ourselves, that we don't live like normal people. And that's just really not the case. Seshe Brewer: It's just a stereotype. We don't wear anything across our foreheads. We don't advertise. Most of us don't even want to be "outed" because of the repercussions we can get and the stereotype...makes things so difficult. (page 17) Pamela: One of the common myths held by many is that mental illnesses result from a weakness of character or a lack of will power. This is not the case. Psychiatric disabilities result from biological and chemical imbalances in the brain. Tina Wagoner: We actually have an illness that just needs to be treated so that our lives can become manageable. So dealing with that, when I first got diagnosed I didn't know why or what was happening to me. But then I realized, you know, I'm a good person, I'm a smart person. And in reality, we are basically very bright individuals. Seshe: We are normal. We can function in society quite well. If I didn't advertise the fact that I have bipolar disorder, people say, "I never would've known," like I have it tattooed on my forehead. What are you supposed to know? Are you supposed to know that I hold down two jobs, that I'm a single mom, that I am a full-time student, that I'm an honor student, that I'm looking for a Ph.D. program, that I'm punctual, that I'm articulate - most of the time, that I can handle just about all the situations and I am probably because of medication and an awful lot of therapy more stable than most people (laugh) are because I have to work so hard at it. So if I ever don't show up some place when I say I am going to be some place, look for me because something's wrong. I am just so consistent at things. Pamela: With many recent breakthroughs in research on appropriate medications, most people with a mental illness are now able to lead productive and healthy lives. Also contrary to popular belief, people with a mental illness are not more prone to violence. The media and entertainment industries continue to portray this disability in a negative light. They have characterized people with it as dangerous and unpredictable. Mark Sullivan: A lot of the public or just other people think that mentally ill people are either violent or stupid, you know, and can't learn. I had an employer one time who would ask me if I got my rabies medication before, you know, I'd come to work at a paint job I had. You know, it kind of stigmatized me a little bit thinking that, well, if I don't have my medicine, I'm going to be going off on people and stuff. (page 18) Pamela: In reality, there is no statistical basis to support the idea that a person with a mental illness is more likely to become violent. In fact, people with mental illness are more likely to be victims of violence than perpetrators. Psychiatric disabilities can affect people of any age, gender, or intellectual group. Though they can occur at any age, the onset of many of these illnesses most commonly occurs between the ages of 18 and 25, the typical age of a college student. You may well encounter students who have just recently been diagnosed and are still coming to terms with this disability. Seshe: I remember years ago I tried to go back to school and I had a real crisis - a real breakdown. And I didn't have any kind of a support system around to keep me strong and I didn't know where to go, and I didn't know about resources, and I didn't have any fight. Pamela: The response of those around the student can play a major role in their ability to accept and adapt to their diagnosis. For many students, deciding whether or not to disclose their disability and register with the office of disability services creates a difficult dilemma. Courtney: When I was hospitalized, let's see, last semester, I had to tell some teachers and I didn't disclose the information because I was just worried what they would think. But I have writing classes and I have written some papers and some information about my bipolar illness and the teachers were just really, really supportive. My writing instructors were really supportive and commended me for sharing with them my experience with what has happened in my life regarding my illness. Pamela: When you have a student who has disclosed a psychiatric disability, simple awareness and understanding can go a long way to make the experience more pleasant for you and the student. The impact of a psychiatric disability on academic performance may vary widely. Some students have symptoms that directly affect their ability to perform academically, while other students may never request or need accommodations. A student's need for accommodations may be sporadic. (page 19) Tina: A student dealing with a mental illness is already going through some personal problems themselves, trying to deal with it, trying to live a manageable life, trying to live as normal a life as possible. And the last thing they need is a professor that is close-minded and does not have an open door policy. I am very fortunate that I had a couple of professors when I was a student in my last year that were just exactly the opposite of that. They had an open door policy. I could call them if I was dealing with some problems and those professors were very encouraging to me. They said, "You know what, Tina? You can do this. You hang in there. You can do this, and if you need help I'm a phone call away." And you know what? I utilized that too. I took them up on that. And in those classes I made straight A's, because the professors were accessible for me and they were understanding. Pamela: The student may not, for example, request accommodations at the beginning of the semester, but mid-semester may have symptoms that require a request for accommodations. This fluctuation of symptoms is a normal part of any chronic illness and should not be interpreted as malingering. Symptoms that may have a direct impact on learning include: difficulty concentrating, fatigue, memory and recall problems, or drowsiness. These symptoms may be caused by the disability or may be side effects of the student's medications. Seshe: I have reactions to my medication just as someone else might have reactions to their medications. It just takes a little longer, I think, sometimes to stabilize on a psychiatric medication, because there's, its not just one or two or three medications, it's a whole cocktail of things that have to be changed around. Tina: I had difficulty concentrating. The medication made me drowsy. I wanted to sleep a lot. Therefore, if I'd sit down to study, I couldn't study very long. Courtney: Right now the medication I'm taking is great, thank goodness. And I'm not having any problems in the classroom. But before, some of the problems that I had were not being able to concentrate, having to get up and down in the middle of class, just not being able to sit still. (page 20) Courtney: And also, I had a semester where I literally flunked out because my medication was causing me not to be able to remember anything. I would study for a test all night long, get up the next morning, and it was gone. Pamela: Because difficulty concentrating and fatigue are frequently associated with mental illness, getting organized and remaining focused will be especially beneficial to these students. Faculty and staff can support students in these efforts in a variety of ways. Support the accommodations recommended for the student by your disability services office. Accommodations might include extended time for exams, a low-distraction room for taking exams, assistance finding note takers, flexibility of attendance policies, and tape recording lectures. Since many students with this and other hidden disabilities do not disclose their disability, you may also want to consider implementing a few suggestions that will help all of your students. Provide early access to the course syllabus or reading assignments. Provide the syllabus and other materials in print and on your course website. Allow students to tape record lectures. Communicate expectations clearly on the syllabus and when describing assignments. Patrick Gray: The biggest problem for me at that time was that the faculty, including counselors, did not know how to handle my situation, how to accommodate me, give me suggestions on what would benefit me. Leah Landis: And with the professors, it's the same way, they don't know whether to keep you going on the same page as we already are and along with the medications. Also, the medications cause us to be drowsy so it is harder for us to take night classes. And I was lucky enough to have a professor that understood and worked well with me that gave me the tests for the night classes during the day, and then I would independently study on those nights that we had the tests. Pamela: When you have a student with a psychiatric disability, building a rapport early in the semester will give the students confidence that you are available to give assistance. Take time to let the student know that you are available to discuss the accommodations he or she needs. Set a clear direction in your course and follow up on how he or she is doing. Encouragement can go a long way. (page 21) Tina: Maybe pull the student aside, and say, "You know, I'm very concerned. I really think you are a very smart individual. Is there something going on that is preventing you from understanding the material, taking the tests, studying? I want you to feel comfortable talking to me. And, you know, you are not here to be judged. We are here to help you because you are attending college to better yourself. And so, as your professor, I want you to know I'm in your corner, and whatever I can do to help, just ask." Mark: The main thing faculty and staff could do to help me overcome any fear of going back to school is just being treated like anybody else, except maybe an occasional pat on the back or "job well done." I think a lot of mentally ill people have low self-esteem. That is something that I'm working on. But that added little just a few kind words or, you know, saying or a note on a test saying, "you did well on this." It would mean a lot. Seshe: I'm not looking for sympathy. I'm not looking to make an excuse. I'm not looking to receive a grade I don't earn. That's the important thing. I want to earn what I have. Its very important because if you give it to me - its senseless. Pamela: We all want to succeed in life. People with psychiatric disabilities are no different. Setting the myths and labels aside and focusing on the student's ability, instead of the disability, you can play an important role in helping the students achieve their goals. [Closing Music] (page 22) References Benica, J., Downs, S., Lefebure, H., Queller, S., and Thornton, M. Make A Difference: Tools for Enabling Faculty to Teach Students with Disabilities. (2003). Project PACE, U.S. Department of Education, Office of Postsecondary Education, #P333A990056. Bowe, F.G. (Ed.). (2000). Universal Design in Education: Teaching Nontraditional Students. Westport, CT: Bergin & Garvey. Hodge, B. and Preston-Sabin, J. (Eds.). (1997). Accommodations-Or Just Good Teaching? Strategies for Teaching College Students with Disabilities. Westport, CT: Praeger Publishers. Lewis, L., Farris, E. & Greene (August 1999). An institutional perspective on students with disabilities in postsecondary education. National Center for Educational Statistics Statistical Analysis Report,. iii-v. U.S. Department of Education. National Alliance for Mental Illness. (2005). An Overview of Mental Illnesses. Retrieved May 9, 2005 from www.nami.org. National Institute of Mental Health. (2002). Medications. Retrieved May 9, 2005 from www.nimh.nih.gov/publicat/medicate.cfm. Souma, A., Rickerson, N., and Burgstahler, S. Academic Accommodations for Students with Psychiatric Disabilities. Retrieved on May 9, 2005 from www.washington.edu/doit/Brochures/Academics/psych.html. University of Washington, DO-IT. (n.d.) Psychiatric Impairment Resources. Retrieved May 9, 2005 from www.washington.edu/doit/Faculty/Strategies/Disability/Psych/psych_resources.html.