In the mental health world, I am best known as a parent advocate for children with mental illness. But in my professional life as an instructor at an open-access community college, I’ve had multiple opportunities to connect students in mental health crisis with the right resources. In this article, I’ll share some things I’ve learned about managing psychosis in the classroom and explain why it’s so important for educators to know the signs and be ready to help. In fact, teachers at all levels are on the front lines of mental health care. Education, empathy and advocacy are critical to ensuring that your students are able to succeed in the classroom and beyond.
Students with serious mental illness face special challenges in the academic environment. Not only can the illness impede their cognitive function, but they may also face the fear and stigma that too often accompany diagnoses like schizophrenia and bipolar disorder. While these illnesses are rare — schizophrenia occurs in just 1 percent of the population — the first serious symptoms often occur right at the age when students are leaving home for the first time and attending college. This is why it’s so important for educators to learn about psychosis and how it can manifest in the classroom.
My school has instituted mental health awareness training for all faculty members, but not everyone is so fortunate. I recommend that all educators take a Mental Health First Aid Course. You’ll learn how to recognize the signs of mental illness and explore effective strategies for connecting students with appropriate resources.
Some signs that educators can watch for include:
- Social withdrawal and isolation.
- Sudden decline in school performance.
- Expression of extreme fear (perhaps refusing to attend class or other school functions).
- Odd behaviors or statements.
- Sudden preoccupation with a narrow topic.
- Clear changes in personal hygiene.
- Difficulty in attending class and completing assignments (Back to School, p. 9).
You may also want to participate in some form of psychosis simulation. If you have not experienced psychosis, it can be hard to imagine how frightening and disorienting this condition can be for a young person who is experiencing it for the first time. The Mental Health First Aid course includes a simulation exercise, and I have linked to some in the Resources section below.
If you see one or more warning signs, don’t be afraid to approach the student. Ask open-ended questions, and be willing to listen. When I notice that a student is behaving in an uncharacteristic way, I try to take the student aside and ask a few questions using a communication model developed by Dr. Xavier Amador, who has dedicated his professional life to helping caregivers to communicate with people in psychosis. His LEAP model is a good guideline for educators: Listen-Empathize-Agree-Partner.
Educators who can recognize symptoms and connect students with mental healthcare have a unique opportunity to promote better outcomes for their students. The RAISE project in the United States has focused on getting help to patients after the first episode of psychosis. Early intervention can be critical to long-term positive outcomes, and in fact, many people can and do live in recovery.
Some educators may wonder about the potential risks of working with students who experience psychosis. While it seems like our social media feeds are filled with stories of violence and mental illness, most people experiencing psychosis, especially in the early stages, are not violent toward others. The risk of self-harm, however, is much greater. I keep my office stocked with National Suicide Prevention Hotline cards, and I am never afraid to ask a student, “Are you thinking about hurting yourself?” and “Do you have a plan?”
Advocating for your students is critical to their — and your — success.
A few years ago, I worked at a small college where my duties included managing paperwork for students with documented disabilities. I have to confess that as a mother of a child (now in college) who lives with bipolar disorder, I was often frustrated by the reactions of a few instructors who felt that students were getting “special treatment.”
Accommodations are not “special treatment.” They are designed to level the field so that students with special needs can succeed along with their peers. A SAMHSA toolkit on inclusion for students experiencing psychosis notes the following: “As is true for many other disabilities, psychosis can lead to multiple additional challenges and obstacles for students, but with the right resources and supports these can almost always be addressed” (Back to School, p. 13).
Over my teaching career, I have seen students successfully complete my courses while managing conditions that range from schizophrenia to bipolar disorder to major depressive disorder. However, it’s also important to realize that as with any illness, health should always come first. Sometimes, I have worked with students to connect them with mental healthcare and encouraged them to return to class when they are better able to manage their illness along with the inevitable stressors of an academic environment. In all cases, I advocate for what the student and I think will best serve their educational and health needs.
I also try to design both my on-ground and online courses with universal design principles in mind. This encompasses everything from closed captioning for hearing-impaired students to make-up work policies and classroom management and attendance policies that benefit all students but can be especially helpful for people who have mental illness.
If you’re ready to make a difference in the lives of your students, you may be wondering where to start. Here are a few resources for educators that I have collected over the years:
I always keep a stack of contact cards from the National Suicide Prevention Lifeline in my office; their phone number is 1-800-273-8255. As many as 10 percent of people with psychosis attempt suicide within the first year of treatment. Don’t be afraid to ask students if they are having thoughts about harming themselves. It’s the first step to connecting them with help.
For more information about Mental Health First Aid and to find trainings in your area, visit https://www.mentalhealthfirstaid.org/.
For an overview of schizophrenia written with educators in mind, see this article from the National Association of Special Education Teachers.
This SAMHSA publication about including students who are showing signs of early psychosis includes a practical toolkit with accommodations examples and inclusive best practices for higher education.
Dr. Xavier Amador has dedicated his professional career to promoting positive and effective communication with people in psychosis. You can watch his TEDx Talk here, and learn more about his LEAP communication model at the LEAP Institute website.
Watch journalist Anderson Cooper as he attempts to work while experiencing a schizophrenia simulation to learn more about how psychosis can affect cognitive function.
Watch a schizophrenia simulation produced by Jannsen Pharmaceuticals (warning: the experience can be intense).
Open Mind of British Columbia, Canada, has collected a variety of resources for educators about mental illness in the classroom.
Schizophrenia and Related Disorders Alliance of America (https://sardaa.org/SARDAA) is a wonderful resource for anyone who wants to learn more about these illnesses.
The International Bipolar Foundation offers a variety of supports and resources, including webinars and local education events (full disclosure: I’m a board member).
The Child Mind Institute is involved in cutting-edge research and provides a variety of educational articles like this one about signs of psychosis in teens.
Find more information on Universal Design and inclusive learning in college courses here.
For more information on RAISE (Recovery After an Initial Schizophrenic Episode), see the National Institute of Mental Health’s website.
One of my favorite books about managing mental illness in college students is Perfect Chaos: A Daughter’s Journey to Survive Bipolar, A Mother’s Struggle to Save Her by Cinda and Linea Johnson. Cinda is a special education professor, but her experience with her daughter’s illness took her knowledge and empathy to a new level. The book is both personal and practical, and it provides a valuable glimpse at the struggles college students and teachers face.