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Transcript of Crisis Abroad
Travel Alert: November 2011
American University of Cairo
Indiana University Locked Up Abroad “The United States plants nearly 300,000 diplomatic land mines around the world each year and the number is increasing. Officially they are known as SACS: Study abroad college students. Most of them are well-behaved [...] but some study abroad students detonate.” -ABC News Rape and Sexual Harassment "Sexual assault is not unique to study abroad. It happens on and around campus as well. However, sexual assault abroad presents additional obstacles and needs its own dialogue."
-Kalamazoo College's The Index 11/2/2011 Mental Illness Conclusion When it comes to risk abroad, who is responsible?
International and/or Study Abroad offices
Important to work across departments
Finding appropriate resources
Managing multiple relationships
Educating the institution as to the risks and institutional responsibilities for these experiences
Our responsibility as professionals Lessons Learned Relevance "Preventable" Most arrests of Americans overseas are drug and/or alcohol related. The Millenial Generation Confident and "invincible" It is important to educate PRIOR to their international experience. Once arrest occurs, very little can be done by the University or the American government . After Amanda Knox case UW tightens restrictions on study abroad Required director clearance, stricter mental health guidelines and requirements, stricter drug and alcohol policies, in depth pre-departure orientations. Good? Bad? International legal systems may not be as "fair" as the American system. Know your rights! Vienna Convention on Consular Relations (VCCR) Resources Department of State Bureau of Diplomatic Security- Overseas Security Advisory Council (OSAC). United States Department of State Education and Preparation! Recommendations for the Field Cannot change international laws Educate! Information about host country, differences in international vs. domestic laws, valuable information for students to carry at all times, etc. Have clear plans and policies Monitor international trends What they can and can't do. Expansion of protest actions
Hamas and Israeli Conflict
32 countries on Travel Warning list
Our Professional Resposibility:
Real risk from perceived risk
Knowledge of current events
Systems for managing risk Case Study: AUC Tweets The New York Times reported tweets from one of the students arrested:
"we were throwing rocks and one guy accidentally threw his phone =(”
"yes live bullets and we have the shells, i was here!!”
"back to Tahrir tonight, as police set fires to everything, no doubt they will blame it on protesters" Lessons Learned AUC
Track all students abroad
Make an institutional decision with Crisis Management Team
Power of Social Media and Defiant Students
Travel Alert & Warning Policies
Is there limited service available?
Reflect on institution's tolerance for risk and ability to respond quickly
May be broad/strict or loose/flexible
“Exceptions” are well documented regarding rationale Best Practices STEP program with State Dept.
Advice from experts:
U.S. Department of State through Embassy and Consular Officials
Overseas Security Advisory Council RISC Staff
Communication with partners in the U.S. and abroad.
Talk to colleagues through SECUSS-L
Gary Rhodes, Loyola Marymount
Julie Friend, NorthWestern University
Develop a process for canceling programs with Crisis Management team.
Avoidance of protest actions in host-country http://www.nbcphiladelphia.com/news/local/134328123.html Caught on Camera Political Unrest Relevance Mental Health:
What does it mean to be mentally healthy?
Used to describe a variety of moods, behaviors, and conditions. Ranges from how a person feels to diagnosed conditions
Specific condition leading to impairment that has been clinically diagnosed.
Education Abroad Professionals must understand the differences between mental health and illness to prepare and respond to study abroad students with mental illnesses and to those who develop one abroad.
(McCabe, 2005, p.53). Mental Illness Concerns: Depression:
Difficult to distinguish from culture shock
Does not just go away
Hesitation in seeking help
Lack of energy / fatigue
Feelings of hopelessness & worthlessness
Loss of interest
Changes in weight / appetite
Thoughts of suicide
Changes in sleeping patterns
***These feelings are normal if experienced in the short-term.
3 Forms of Depression:
Major Depression / Clinical Depression
While common among college students, often goes unrecognized.
(Lindeman, 2006, p.11-13). Mental Illness Concerns: Suicide Indicators:
Talks or jokes about committing suicide
8 out of 10 people who commit suicide (Settle et al., 2004, p.11)
Engages in self-destructive or risky behavior
Makes statements that seem hopeless
Has persistent difficulty eating or sleeping
Gives away possessions
Loses interest in family, friends, and/or activities
Preoccupied with death & dying
Loses interest in personal appearance
Suddenly increases alcohol or other drug use
Makes a will or other final arrangements.
(Lindeman, 2006, p.14-15) Mental Illness Concerns: Anxiety:
Types of Anxiety Disorders:
Generalized Anxiety Disorder (chronic)
Post-Traumatic Stress Disorder
Obsessive-Compulsive Disorder (OCD)
Eating Disorders (Anorexia, Bulimia, Binge Eating Disorder)
Attention Deficit Hyperactivity Disorder (AD/HD)
Typically surfaces during adolescence and early adulthood, during a student’s college years.
Only 1 percent of the general population is diagnosed, not a common disorder among students studying abroad.
(Lindeman, 2006, p.19-24). Why is this relevant to Study Abroad Professionals?
No longer taboo. More students are admitting to mental illnesses and able to attend higher education due to medications available (McCabe, 2005, p.52).
Suicide is the second leading cause of death amongst college students in the 18 to 24 age group (accidents is number 1).
Most suicidal people are depressed although not all people experiencing depression are suicidal.” (Lindeman, 2006, p.14).
Rate of students attempting suicide is 10 times the rate of completed suicides (Marano, 2004).
Number of higher education students taking psychiatric medications is rising. Percentage has increased from 9 percent in 1994 to 24.5 percent in 2003-4” (McCabe, 2005, p. 52)
20% of college women have a diagnosable eating disorder (Settle, et al., 2004, p. 15).
Findings from National College Health Assessment (ACHA, 2010, p.14-15).
At any time within 2009, 29.6% of students felt so depressed it was difficult to function
Triple the number 15 years ago (Fischer, 2010).
Only 7.5% were diagnoised or treated by a professional
At any time within 2009, 48.7% of students felt overwhelming anxiety
Only 8.4 % were diagnozed or treated by a professional
At any time within 2009, 5.6% of students seriously considered suicide
At any time within 2009, 1.3% of students attempted suicide
At any time within 2009, 4.6% of students intentionally cut, burned, bruised, or injured themselves Relevance International Exchange & Stress:
New layer of stress
Notion that study abroad can allow students to escape or avoid difficult situations at homeor school
Contributing mental and psychological factors:
Loss & separation
Adjusting to local conditions
Preexisting or dormant conditions
Change in Medication
Changes in medication, doses, and termination of medication
Ex: Bad news back home, death of a loved one, terrorism, political violence, health scares
(McCabe, 2005, p.54-55) Relevance Depression Case Study: Mark
Study abroad participant in Barcelona
Never left host family home, excessive sleeping, lack of friends, constantly sad, feelings of isolation
Host family and immediate family expressed concerns.
Parents wanted to move his homestay, belief that it was a character building experience
Resident Director’s Impressions & Interactions:
In meetings, Mark was emotionless, expressed signs of crying, confessed he hated Barcelona, and disliked students and program
Director learned more about his personal life, revealing social interaction and family trouble back home. In his life in the US, Mark had roommate problems, few friends, and difficulty connecting with father. Mark felt that going abroad was something different and would be good for him.
***This distinguishes this case from a culture shock one.
Through expressions or support and active listening the Director was able to learn about Mark’s personal life and learn that major depression was at work.
The Director did not force a solution, demand Mark to go home, or for him to see a psychologist. Forcing a solution can cause difficulties with parents and make it more difficult to resolve.
The Director was careful to make sure Mark knew he supported and wanted to help him.
The Director directly raised the issue of suicide.
Father’s disappointment that Mark came home and expressed feelings that his son was weak.
Mark refused to see a psychiatrist but after willingly seeing a program physician the doctor confirmed depression.
(Lucas, 2009, p.195-197). Mental Illness Anxiety Case Study: Darlene
Study abroad participant in Barcelona
Darlene had trouble breathing and experienced a panic attack
None, Darlene was doing well in the program, seemed to be enjoying herself, and had friends
Resident Director’s Impressions & Interactions:
Through support and active listening Director discovered Darlene was assaulted at a payphone and groped by two men who tried to pull down her skirt.
Darlene reveals to the Director she had experienced a date rape over a year ago which she had never told anyone.
The assault at the pay phone triggered post traumatic stress causing the anxiety and panic attack.
Most Important! Director spoke with her several times to establish trust and support.
Director spoke with her several times to establish trust and support
Darlene was given the option of seeking professional help in Spain or return home to the US and seek out help.
Darlene ended up going home to seek professional help.
(Lucas, 2009, p.199-200). Mental Illness EATING DISORDERS:
Predeparture Advising & Behavioral Contracts
Talk Openly and Ask Questions (Offer to listen, refer student to a professional evaluation, consultant with professional
Stress the Seriousness (to all students and those working with students
SCHIZOPHRENIA & PARANOIA:
Help the Student Arrange Medical Care
Encourage Treatment Compliance
Ask a Mental Health Professional for Assistance
ATTENTION DEFICIT HYPERACTIVITY DISORDER:
Rely on a Professional Diagnosis
Encourage Student to Learn about AD/HD
Refer Student to Counseling
Encourage Good Self Care
(Lindeman, 2006, p.13-26). Mental Illness
NAFSA Checklists DEPRESSION:
Connect students to a mental health professional
Offer emotional support
Take suicide ideation seriously
Care for yourself
Take it seriously
Be direct about the issue – ask
Remove the means to commit suicide
Do not leave the person alone
Do not be sworn to secrecy
Never call the person’s bluff
Encourage Good Self Care
Limit Stress-Inducing Chemicals (Caffeine, tobacco, alcohol, marijuana, cocaine, and other drugs)
Increase recreational/Relaxing Activities
Encourage Time Out
Monitor Stress-Inducing Thoughts
Encourage Participation in Activities
Make a Referral When You Suspect Signs of a Disorder Examples of Current Resources for Students:
The US Department of State addresses mental health for students stressing the important of having a workable plan while abroad.
Luther College has a guide for students with mental illnesses who want to study abroad and for those that experience mental health issues while abroad
NYU makes counselors available twice a week
Carnegie Mellon has an health & safety guide
Difficulties & Challenges:
Distinguishing between culture shock
Legislation & Legal Environment
FERPA (Family Educational Rights and Privacy Act)
Stricter standards of professional conduct for Doctors.
Students reluctant to seek help
Managing multiple relationships
Lack of resources, training & time
Stress & burnout
(Lucas, 2009, p.202-6). Mental Illness Mental Illness Current Policies in Place:
Planning for continuing care and potential problems.
Some colleges require behavioral contracts for at-risk students
Contracts detail treatment and agreement to continue prescription medications, etc.
Availability of drugs, illegal vs. legal, replacement drugs (Fischer, 2010).
Training for education abroad professionals & acknowledgement of limits
Example: St. John’s University instructs all faculty and staff members on mental-health issues
Acknowledgement of limits & utilizing appropriate resources
Identifying temporary mental health providers overseas
Addressing insurance coverage
(Fischer, 2010) Recommendations for Education Abroad Professionals & Resident Directors:
Establishing trust and network of support
Written Policies for responding to Mental Health Crisis
Establish chain of command and contacts
List of local & US mental health professionals
Understand privacy guidelines and laws
Have student sign Code of Conduct
Availability to Resources & Training to Resident Staff Overseas
Establish partnerships with Study abroad and Campus Mental Health
Know your boundaries
Acknowledge Impact on Other Students Document interventions
(Settle et al., 2004, p.13).
(Lucas, 2009, p. 209) Lessons Learned References: ACHA: American College Health Association. (2010). University of Buffalo Executive Summary 2010 of National College Health Assessment II. Available from http://www.student-affairs.buffalo.edu/shs/wes/10nchap.pdf.
Fischer, K. (2010). Study-Abroad Programs Should Be Prepared for Mental-Health Crises, Speakers Advise. The Chronicle of Higher Education. Retrieved from http://chronicle.com/article/Study-Abroad-Programs-Should/65759/.
Lindeman, B. (Ed.). (2006). Best Practices in Addressing Mental Health Issues Affecting Education Abroad Participants. NAFSA: Association of International Educators Publication. Retrieved from http://www.nafsa.org/mentalhealth
Lucas, J. (2009). Over-stressed, Overwhelmed, and Over Here: Resident Directors and the Challenges of Student Mental Health Abroad. Frontiers: The Interdisciplinary Journal of Study Abroad, 18, 187-215. Retrieved from http://www.frontiersjournal.com/documents/FrontiersXVIII-Fall09-JLucas.pdf.
Marano, H. E. (2004). The Mental Health Crisis on Campus in Leadership Exchange. Washington, DC: National Association of Student Personnel Administrators (NASPA).
McCabe, L. (2005). Mental Health and Study Abroad: Responding to the Concern. Education Abroad – International Educator. Retrieved from http://studyabroad.isp.msu.edu/safety/presentations/MentalHealthEducationAbroadNovDec05.pdf.
Settle, W., Albers, S., Blake, E., Gaw, K., Hickman, L., Hogan, I., Newport, N., Shoup, J., & Utz., P. (2004). Mental Health and Crisis Management: Assisting University of Notre Dame Study Abroad Students, 2nd edition. Notre Dame, IN: University of Notre Dame Counseling Center. (46556). Relevance 1 in 5 college women are raped during their college years
Only 5 percent of rapes are reported to law enforcement officials
Cultural differences and misunderstandings can invite sexual harassment and rape Resources Pre-departure Education
NYU Policies and Procedures Concerning Sexual Assault
University Health and Safety websites
University pre-departure brochures/PDFs
US Department of State Current Policies Subject to the laws of that country
Reporting assaults and rapes varies depending on school/program Lessons Learned - Prevention Integrate into their community
Make friends with the women of the culture/vilage
Learn from the women about self protection and practice it
Dress according to local customs
Interact with men according to local customs
Behave according to the local customs
Stay in control - Stay sober
Have a buddy system with someone that you trust
Pay attention and trust your intuition Future Recommendations Encourage reporting of sexual harassment and rape
Ensure that reported accounts are followed up
Notify university officials at home campus Fay vs Thiel College Sick female student brought to medical clinic in the city of Cusco
Once admitted, all faculty and students left on a prescheduled trip
Student was left alone at hospital
She was subjected to the unnecessary surgical removal of her appendix
Before removal of appendix, she asked for other alternatives and was denied
She was sexually assaulted during the surgery by the surgeon and anesthesiologist Topics Covered Political Unrest
Locked Up Abroad
Rape & Sexual Harassment
Mental Health "In times of emotional and physical distress, 'culture' can transfigure a crisis, and how it conditions why people react the way they do." American Entitlement "We used to think that revolutions are the cause of change. Actually it is the other way around: change prepares the ground for revolution."
-Eric Hofer Case study: NYU Tel Aviv NYU Tel Aviv campus evacuated
11 students with faculty, flew from to NYU’s campus in London.
Transfer to another NYU campus in London, Prague, Florence, or New York.
Informed decision: Risks increase as crisis develop and options decrease as crisis develops Peace Corps. Crisis Management Handbook
NAFSA “Effective Crisis Management”
Michigan State University presentation on Revolution and Disaster Abroad
SAFETI Clearinghouse Resources
Ritchie, Mark A (2012)"Risk Management in Study Abroad: Lessons from the Wilderness" Resources