Mental Health Condition

About one in five Australians experience a mental health condition in any one year. There are a wide range of conditions and their impact on individual students varies greatly. These may include schizophrenia, depression, bipolar disorder, post-traumatic stress disorder (PTSD), eating disorders such as anorexia nervosa, anxiety, and poorly-understood conditions referred to as personality disorders. The most common mental health conditions are depression, anxiety and substance-use disorder.

The onset of a mental health condition typically around mid to late adolescence, and young Australians (18-24 years old) have the highest prevalence than any other age group.

A Mental health condition is diagnosed by a mental health practitioner.

Mental health conditions may be transitory or of longer duration, with symptoms ranging from mild and episodic to severe and ongoing so that students may require academic accommodations at some times but not at others.

The impact of these ‘invisible’ disabilities might not be immediately noticeable but can include anxiety, panic attacks, limited attention span, fluctuating motivation and disorganisation. These may be accompanied by unpleasant physical effects, such as rises in temperature, sweaty palms, difficulty in breathing and heart palpitations. Students taking prescription medication may experience drowsiness, persistent thirst, vision difficulties, and problems with coordination. Students experiencing an episode may be either unusually withdrawn or hyper-interactive with others, or erratic in their behaviour.

Impact of Mental Health Conditions

The learning processes of students with a psychiatric or psychological disability may be affected in the following ways:

Students may have frequent or unexpected absences. These may be due to hospitalisation, medication changes, or fluctuations in their illness.
Students may display rigid thinking patterns and inflexible approaches to tasks.
Students may isolate themselves from others.
Students may tend to rote learn or may have difficulty performing consistently or following through on tasks. This can be due to anxiety, and perceptions of inadequacies.
Severe anxiety may significantly impair participation in tutorials and performance in examinations.
There may be short-term memory loss which will affect both the ability to recall information and attention span.
Students may have difficulty following sequences, complicated instructions and directions, and with integrating material from different sources. They may be easily ‘overwhelmed’ by information.
Students may ask questions repeatedly, return frequently to issues already covered, or repeat things.
When students are unwell they may be inclined to misinterpret questions, comments, instructions or be vague in their responses to questions. Some students may misinterpret non-verbal cues in particular.
When they are unwell their behaviour can also be perceived as impulsive or unpredictable.

Teaching Strategies

There is a range of inclusive teaching strategies that can assist all students to learn but there are some specific strategies that are useful in teaching a group which includes students with a mental health condition.

The effects of a mental health condition vary enormously so it is important to discuss with students their needs and how these might be accommodated:

Students with a mental health condition may find regular attendance at classes difficult so it is useful to clarify expectations regarding attendance with the student. Making reading lists and handouts available early in the course will assist students who may be frequently absent to continue with their learning, even though they may be unable to attend classes.
Anxiety is common among students with psychiatric disabilities. Severe anxiety may reduce concentration, distort perception, and interfere with the learning process. Students who are anxious about workload may benefit from tailored reading lists, with some guidance to key texts.
You might allow work to be completed on an in-depth study of a few selected texts, rather than a broad study of many.
It may be helpful to provide an individual orientation to laboratory equipment or computers to minimise the anxiety likely for some students in unfamiliar learning situations.
Some students with a psychiatric or psychological disability may be over-sensitive to what they perceive as criticism from others. They may prefer verbal to written feedback on assignments.
Recording lectures will assist those students whose attentional processing is affected by their disability as well as those who, because of the effects of medication and/or short-term memory loss, may tend to misinterpret or misquote.
Flexible delivery of teaching material via electronic media is particularly helpful for students who are unavoidably absent from class or who cannot participate in classes for extended periods of time.
Sometimes student behaviour may be challenging for teaching staff and other students.

Assessment Strategies

Once you have a clear picture of how the disability impacts on learning, you can consider alternative assessment strategies. Note that equal opportunity, not a guaranteed outcome, is the objective here. You are not expected to lower standards to accommodate students with a disability, but rather are required to give them a reasonable opportunity to demonstrate what they have learned. Some suggested strategies are outlined below:

Absences due to hospitalisation or the effects of changes to medication may affect the number of assignments students are able to complete satisfactorily. In such cases you might consider redistributing the weighting of assignments. For example, you might set six assignments for a semester, but inform students that only the best four marks will be counted. Students who have been absent or unwell will thus have some choice about what and how many assignments they submit.
Students who are anxious about performing in front of others may prefer to video-record any presentations which are to be assessed or make a one-to-one presentation.
Some students may need extra time in examinations or require a separate room free from the distractions which may contribute to anxiety or trigger panic attacks. Take-home examinations may be an option for these students.
Keep short your written examination instructions and sentences within examination questions. Questions using bullet points, lists or distinct parts are more likely to be followed and correctly interpreted, particularly by students who are anxious.
Students with memory loss, reduced attention span or deficiencies in short-term memory will have difficulty with multiple-choice questions. Short-answer questions are likely to be a better test of their knowledge.
Assessments should be postponed for a student experiencing a severe episode of their mental health condition. If the cut-off date for withdrawal without fail has passed, students should be counselled to seek advice from the disability adviser regarding their situation.