Providing Learning Support for Students with Mental Health Difficulties Undertaking Fieldwork and Related Activities

Further Information

Named problems

Agoraphobia

Usually interpreted as a fear of open spaces but actually most often a fear of people-occupied spaces such as supermarkets, shopping centres, football games, rather than vastness or emptiness. One of the more common of a huge list of phobias. Most of us have mild phobias which we can manage without them interfering with normal life. If a student declares themselves as agoraphobic it probably means that they have experienced it sufficiently severely for it to prevent them leaving their home, or at least going out unaccompanied. They may be currently managing to get to lectures etc. with some treatment, either medication or behaviour therapy. They may be worried about whether they can cope with the unfamiliar places and circumstances of fieldwork. If a student has declared themselves on a health and safety form then a conversation with them about the circumstances they feel most likely to lead to severe anxiety or a panic attack would enable you to jointly plan to avoid those triggers. You should also ask what action is appropriate if they have a panic/anxiety attack — they may have medication for that. Reassurance that they would be always with a friend or in the same small group may also help; knowing that people around them are understanding goes a long way to relieving the anxiety about having a panic attack which can close more doors than necessary. See also anxiety

More information:

Alcoholism

Not referring to the excess consumption of alcohol which seems to traditionally accompany some student fieldtrips, but to a chronic problem for an individual student which could affect their ability to participate in any fieldwork. A declared alcoholic will be a recovering alcoholic, almost certainly on a recovery program. For those for whom alcohol has become an addiction, recovery almost certainly involves avoiding it altogether. Fieldtrips create enormous social pressure to conform with a hard-drinking student stereotype, and tutors could plan to reduce this social pressure by not participating themselves and by arranging alternative activities which would acknowledge the needs of all those who are uncomfortable with heavy drinking. Many students suffer more anxieties about the social circumstances of field trips than about the academic or physical demands. Evenings with planned work-related activities giving them a clear role, and some sort of structure, are more supportive than 'free time' which leaves them facing social demands or isolated in their room.

More information:

Alcoholic blackout:

Alzheimers

One explanation for memory loss and increased confusion with age. It can occur in younger people. (See also brain damage.) Very unlikely to be declared since it is unusual to diagnose it in the early stages when someone would still be managing higher education. Some students of retirement age may be a little worried about their age affecting their ability, but this is more likely to be associated with recall necessary for examinations than with the specific challenges of fieldwork If a student on fieldwork seems to have severe problems with losing equipment, or difficulty recalling simple domestic details, there are other more likely explanations, even if they are elderly. General stress or anxiety, or medication for another condition should be considered.

Anorexia

Anorexia, as with bulimia and self-harming, is not about the obvious issue (i.e. thinness). Anorexic behaviour is not susceptible to rational arguments about 'the need to eat'. On fieldwork anorexia may become apparent to other students and tutors for the first time, and may cause distress, but rarely danger. The sufferer feels shame and fear, and providing an understanding environment within the fieldwork group (specifically avoiding conflict and anxiety about someone who 'won't eat') is probably best practice. The 'Changing Minds' leaflet (http://www.rcpsych.ac.uk/campaigns/cminds/leaflets/anor/anor.htm) is designed to help others understand anorexia and is an excellent brief insight into the world of the anorexic to which it would be useful to refer other students, as well as tutors, for better understanding.

Be aware that an anorexic student will not be fit to tolerate non-standard weather conditions and physical strain, and this physical frailty should be planned around as with other physical limitations. As an anorexic student may not be able to acknowledge that they are thinner than average you may need to intervene to protect them from vulnerability to hypothermia etc.

More information:

Anxiety

Uncomfortable levels of anxiety are experienced by people for all sorts of different reasons. Anxiety is a component of many mental health problems which might be relevant to inclusive fieldwork planning. Understanding anxiety is therefore key.

"A diagnosis of anxiety is likely to be made for someone displaying fear or pathological anxiety in situations which would probably not provoke similar feelings in other people. The anxiety may be associated with a particular object or situation (generally referred to as a phobia) or it may affect a person in a generalised, all-pervasive way (sometimes known as 'free-floating' anxiety). Examples of phobias include claustrophobia (fear of enclosed spaces), agoraphobia (fear of being away from the security of one's home)and social phobia (fear of meeting people). The level of anxiety can vary; 'panic attacks' occur when the level of fear rises suddenly and sharply (for example, when speaking in a group or being trapped in conversation with another person without having any natural exit)." (Open University, 1996, p.23).

A student with anxiety may experience physical sensations (palpitations,sweating, stomach pains, headaches). They may be easily discouraged, and have low esteem. They may display unwarranted concern for detail (e.g. in instructions or during data collection) or for perfectionism (e.g. in group work or the presentation of results). They may make excessive demands on the tutor for advice and support about matters of a trivial nature. Difficulties may be encountered with fieldwork due to one or more of the many aspects of it which differ from other study, and successful group work may depend on understanding from other student members.

Anxiety related to group work may have become apparent prior to the fieldwork itself, and including group work in preparatory activities will help ensure that this stimulus is met and accommodated before working away from the usual environment. However many stimuli to anxious conditions will not occur until you are away. If the student has an opportunity to explain their fears beforehand, for example on a questionnaire or in a one-to-one tutorial, then you will have been able jointly to arrive at a plan of action to support them. If the problem does not surface until you are in the field then you may be able to help by meeting with the student away from the main group and trying to establish the main causes of anxiety. For a student who has experienced panic attacks in the past the dread of one occurring is often the overriding sensation or concern. Together you can arrive at a plan of support during the fieldwork, which may involve agreed 'rules' to create a more supportive structure for the student, such as place and time of access to tutors, formal time for group work, alternatives to certain fieldwork activities. Such a structure will help tutors and other students also. Try to be positive and give encouragement at all opportunities during the fieldwork

Excellent prose 'the alien within' for empathy:

Panic disorder:

Social anxiety:

Marijuana and panic attacks:

Aspartame and panic attacks

For those who suffer from anxiety:

Asperger's Syndrome

Students with Asperger's Syndrome (AS) may be described as 'having a dash of autism'. Autism covers a wide spectrum and most of us are more familiar with the image of an autistic child who may need intensive support to participate in even basic education. We probably also know that autistic children tend to be very intelligent, but that it is socialisation obstacles that have to be overcome — and the severity of these means we are unlikely to see an autistic young person in higher education. In contrast we are very likely to encounter AS in higher education and see it only as slightly odd or unusual behaviour, perhaps in a student who shows exceptional ability in their academic studies. There are probably many undiagnosed AS students, since the description of AS really fits the caricature of an absent-minded boffin — and academia is the realm in which the benefits of AS are rewarded. Fieldwork, however, is not the same. Socialisation difficulties which may be secondary in lectures and examinations tend to be highlighted. An inability to 'read' other people and their responses, typical of AS, can make working in groups difficult. While the rest of the group (and perhaps their assessment) suffers, the AS student may feel very hurt and isolated — not understanding what it is they are missing and unable to express their feelings. AS is also a condition which generates anxieties which the student may reduce by list-making (train-spotter syndrome) and they would benefit particularly from details of travel and accommodation arrangements, and the time to absorb these details in their own way. They may also have little obsessions about personal behaviour or domestic rituals which could concern other students unless they understand that it is necessary to reduce personal anxiety.

More information:

Personal view of an Open University student:

About educating the (younger) student with AS, and also students on autism:

Autism/autistic

"People with a diagnosis of autism may experience difficulties developing social relationships, communicating and may have a tendency to isolation... (the student) with this diagnosis may appear disconnected from the social environment: he or she may have problems with speech or conversation and may, in addition, be unable to recognise, interpret or learn from body language, changes in tone of voice, facial expressions and metaphoric speech" (Open University, 1994, p.25).

Severe autism is likely to preclude a student reaching higher education, but some form of mild autism, including Asperger's Syndrome, may be fairly common, especially since one facet of the condition is usually a very high level of intelligence, ability or knowledge in an intellectual domain.

To overcome the tendency to withdraw, education for an autistic person is achieved through a very structured process, with explicit rules and strict routines. Away from the home base it may be particularly difficult to put such a structure in place, and for it to be effective in the time available. Group work and tutorials may be difficult, with the student seeming withdrawn or self-absorbed, and the student may then suffer feelings of isolation and rejection. On fieldwork, and with the groupwork which it usually involves, the opportunities for this are multiplied. Try to make arrangements for one-to-one support, and to be positive and friendly even in the absence of normal feedback. If the student has idiosyncratic behavioural traits (e.g. grimacing) which could be unsettling to other students, ask for their permission to explain the circumstances to the rest of the group.

The Open University view on attendance at residential summer schools is relevant here:

"Attendance at a residential school could lead to great difficulties for the student in view of his or her dependence on people and situations with which he or she is familiar. Very thorough preparation may be required, including the involvement of a friend or relative as a personal helper. Excusal may be a sensible option to discuss with them" (Open University, 1994, p.26).

Teaching students with autism:

Advice from an autistic person about how you can best help:

'This is the place where I tell you about my autism' David Andrews:

Bipolar depression

This used to be termed 'manic depression' and the descriptions of feelings in the section depression apply also here. The difference is that the student may also experience phases of 'mania' meaning only hyperactivity, sleeplessness, and untoward energy. These phases are usually very infrequent and medication for bipolar depression tends to eliminate or reduce the manic phases. If a student declares themselves to be suffering from bipolar depression, a conversation with them about triggers for their manic phases, and a suggestion that they consult their doctor about the fieldwork activities may help — but generally vigilance about medication (and therefore regular mealtimes and routine daily activities both of which assist all those on medication) is what matters. Ask the student how a manic phase may start and what should be the response — and a phone number for their GP or 24 hour support. It would be wrong to behave as if a manic phase is inevitable — depressive symptoms are more likely to be the obstacle to effective fieldwork — but on the rare occasion it happens other students may be disturbed, and the student concerned might put themselves in danger by over-zealous investigation of the physical environment.

Lithium is fairly widespread medication and worth knowing a little more about.

More information:

Bipolar depression and marijuana:

Lithium, what it is and what to do if missed:

Brain damage

An outcome of an accident earlier in their life may mean that a student has a particular mental difficulty. As with stroke damage this could vary enormously, affecting any part of brain function. It is included here because sometimes slightly 'strange' behaviour — which could be social, and therefore manifest itself in groupwork, or it could be attitude to risk — has this explanation rather than a mental 'illness' subject to control by medication. Brain damage (including stroke) can leave people with obvious speech impediments, but alternatively with less obvious communication problems such as an inability to read social signals, a difficulty in finding the right word (and frustration over that), a tendency to tire mentally and perhaps then appear confused, a difficulty with instantaneous decisions. To help overcome fieldwork obstacles you need the information from the student beforehand, but if their group is able to be supportive rather than reacting warily there should be no problem in making the fieldwork accessible. Medication is unlikely to be an issue in terms of modifying behaviour. After stroke, medication is to reduce the chance of further strokes and after both stroke damage or accident trauma this might include anti-depressants (see depression).

Bulimia

Bulimia is an eating disorder and closely related to anorexia. A person suffering bulimia avoids feeding their body by eating (even binge-eating) and then making themselves sick later, a strategy which is more private than anorexia and less likely to be known prior to residential fieldwork. As with anorexia and self-harm a person suffering in this way is ashamed and afraid of discovery, but their fear of what will happen if they do not make themselves sick is so great that they must do it to release tension. In a fieldwork situation a feeding disorder is unlikely to progress to a dangerous point and management by understanding and avoiding conflicts is probably best. Obviously a student should be counselled to seek professional help on return. Distress levels all round can be reduced if other students and staff appreciate that a student with bulimia wants to be able to deal with unbearable anxiety in the only way that works for them, and that this does not threaten their immediate health or the health of those around them.

More information:

Bulimia and substance abuse:

Claustrophobia

Fear of enclosed spaces. If a student declares this it probably means it is quite severe, and could lead to panic attacks or severe anxiety symptoms. (See also anxiety.) Discussion with the student beforehand should establish which circumstances are likely to give them most problems, and how they would prefer to manage — a supportive student group, medication (and if so, how long before the event), avoidance of the place altogether. Not just caves and mines, but some buildings, lifts, the Underground, coaches and airplanes, rooms without windows (including hotel rooms and toilets).

Dementia

A general term for deteriorating brain function, usually in the elderly. See Alzheimers, brain damage. For a student reported by others as behaving in a 'demented' fashion see bipolar depression, schizophrenia, and consider substance abuse.

Depression

"A diagnosis of 'clinical' or 'unipolar' depression may be in response to moods of profound sadness which seem out of all proportion to the person's circumstances or life situation... (a student) with such a diagnosis may display a mood of overwhelming despair, guilt, loss of drive, apathy or be unable to accomplish the simplest of tasks." (Open University, 1994, p.24).

Fieldwork occurs over such a limited and intensive period that depression is unlikely to suddenly manifest itself — a more likely scenario is that a student who is already experiencing depression has to decide whether they can face the fieldwork or, having opted to give it a try, find themselves unable to participate effectively. Attending fieldwork may actually relieve the depression and enable more effective learning for the student, but be prepared for the feelings they experience to be unchanged by normal outside stimuli. Give praise and encouragement, but also be clear in your own mind about the limits to the support that a tutor or other students can offer.

More information:

More information on symptoms, and further links including antidepressants, bipolar (manic) depression and personal web pages:

Depression in the workplace (a rather managerial view):

Ecstasy and depression:

Manic depression

Manic depression is now referred to as 'bipolar depression'. Periods of deep depression (recognised and experienced in the same way as depression itself) give way to manic phases when the person behaves in an excited, over-active way. The student may behave extravagantly, talk incessantly, have inflated self-esteem, sleep very little and show signs of irritability or aggression.

Obsessive/compulsive disorder (OCD)

A term for anxieties manifested as compulsions to do certain things either repeatedly or excessively thoroughly. Washing and checking are common compulsive behaviours. On fieldwork room-sharing and groupwork can mean that these relatively minor mental health problems may precipitate social problems. Solutions probably rest in overt recognition of the compulsion or obsessive behaviour by the student concerned and by the rest of a group as something to be worked around, and not threatening or deliberately annoying behaviour. General anxiety is likely to increase or trigger such behaviours in those who are susceptible, so reducing anxiety on fieldwork, as suggested elsewhere in this site, will help.

OCD and young people:

More information including case studies and students:

Paranoia

Not a helpful label. If other students describe someone's behaviour as 'paranoid' they may mean obsessive/compulsive behaviour, including the sort of attention to detail which can characterise Asperger's Syndrome, or they may be referring to hallucinations or delusions. The latter might be part of schizophrenia, or relate to substance abuse.

Phobia/phobic

Something which triggers a panic attack or severe anxiety symptoms may be described by someone as their 'phobia'. There are many phobias, and a useful list can be found at http://www.phobialist.com/class.html.

The main point is to plan the fieldwork experience to avoid a serious phobia, and to be prepared with what to do in the event of the student suffering a panic attack. Talk to the student about any declared phobia prior to the field trip and take the opportunity to ask how they manage their anxiety in the 'phobic' situation — it may be a question of them having appropriate medication with them. Those who suffer from panic anxiety spend much of their life being afraid of having the next panic attack — if you can help them feel in control of the experiences fieldwork will involve, you will do much to reduce their overall stress, and perhaps open up some areas of learning to them.

Schizophrenia

If a student declares schizophrenia, the management of their fieldwork experience is rather crucial. The fact that their mental health is already sufficiently managed for them to be coping with higher education demonstrates that there need not be a problem with fieldwork. Medication is the key, and alcohol, recreational drugs or missed medication due to non-routine activities are therefore the main risk factors in residential fieldwork. Under control of medication the only difficulties may be side-effects of the medication (see below). If medication is disrupted the behaviours associated with the mental illness may manifest themselves, which can include delusions and irrational thought, disturbing for other students and possibly leading to increased risk-taking. Violence is a very small risk. However, there are serious circumstances in which access to medical assistance is important — be prepared with telephone numbers for appropriate local professional assistance, and ensure the student has discussed the fieldwork with their own doctor prior to leaving, giving you 24 hour access to advice.

What is schizophrenia?
"The commonly held view that a diagnosis of schizophrenia implies a dual or split personality is incorrect. It is possible that people with the diagnosis may experience intermittent difficulty distinguishing between their own and other people's realities. This may be where the notion of a 'split' originates. Other types of difficulty experienced by the person may involve disturbance or disorganisation of thought, feeling or behaviour. Some people with this diagnosis appear very withdrawn; there may be a lack of drive or interest, a lack of will-power or a blunting of emotions. The person may intermittently experience unpredictable emotions or hallucinations (e.g. hearing voices), or may speak in a way others find unintelligible. A person with a diagnosis of paranoid schizophrenia may experience delusions of grandeur or persecution. Many people with a diagnosis of schizophrenia manage their lives with the help of drugs. For some, the side-effects of drugs are unacceptable. Counselling, psychotherapy or living in a supported environment can help. People diagnosed as having schizophrenia are rarely violent." (Open University, 1994, p.25).
What tutors and other students should know

Side-effects of medication include both lethargy and extreme restlessness. The latter may be disturbing for everybody concerned on fieldwork, but it is beyond the student's control. It is very likely that this would already be known from earlier classes, and it would be helpful to other students for the cause to be explained if the student concerned agreed to that. Other difficulties arising from the condition itself also have the potential to disturb the student group, such as inability to sustain a line of rational argument; branching off into (some highly personal) irrelevancies; susceptibility to distractions; complete disengagement from study. Over a long period of time encouragement of group activity for this student may be very beneficial for them. In the short term of a field trip, you may find the need to put the other students first. Certainly it would help to have their understanding, and to be able to reassure them about the unthreatening nature of unpredicted behaviour, and advice on who to inform, but this does depend on agreement of the student concerned. Perhaps such agreement could be made a condition of attendance on fieldwork. Contact with the student themselves should be calm, consistent and sympathetic. On fieldwork it is particularly difficult, but important, to maintain regular and predictable contact. Ensure that medication is available and used, and that you, the tutor, know where to go for professional support (e.g. GP, local hospital, student's own doctor) if needed.

Top ten things you need to know (recommended!):

More information:

Use of amphetamines can mimic schizophrenia symptoms:

Self-harming

Self-harm, including cutting, is not rare in the student population. It is usually concealed, and the problem with fieldwork is that it becomes public (as with bulimia). Those who self-harm are unlikely to be attempting suicide, although it may appear to others who witness it that this is what is happening. On fieldwork it is other students who are likely to report evidence (e.g. cut marks on wrists and forearms) to a tutor, and the priority will be to assess whether this is an acute crisis or an ongoing condition. (See also suicide for the sort of questions to ask to establish suicidal intentions.) As with anorexia and bulimia, the action of the sufferer is something they do to release unbearable pain or fear of not doing it. It is not to seek attention and it is not susceptible to rational argument. As with eating disorders the student needs an understanding environment, and should be counselled to seek professional help on return. You do need to consider the other students, who would find this distressing, and the self-harmer can be told that taking this action in front of others is unacceptable, and that they will be asked to leave if they do so.

More information:

insight — see the excellent 'secret shame' site at:

Senility

See Alzheimers.

Stroke

See brain damage.

Suicidal

The crucial question is 'Are they serious?' The Web is extremely helpful in suggesting how you find this out, providing actual questions to ask (see below). Basically if a student is seriously depressed and feels hopeless, has a past history of suicide attempts and/or has made concrete plans or preparations, they are at high risk. It is acceptable to ask these questions, and you will get answers, so do ask them. Talking about it won't make it more likely.

More information and questions to ask:

Stress and suicide:

Tourette's syndrome

Uncommon, and manifested in uncontrollable movements or repetition of words — an extreme form of a 'nervous tic' which can be alarming for others. Likely to be declared and already known before the fieldwork. Management means providing knowledge and understanding for the student group.

More information:

See also 'twitching' at:

and 'dystonias' at:

Vertigo

Very relevant for field work. See phobias and consider managing anxiety or panic attacks.

Page updated 14 December 2001

GDN pages maintained by Phil Gravestock