A Bystander Training Intervention Could Save a Life By Dr. Catherine Sanderson

Training students to help friends can reduce the college mental health crisis.

  • Many college students struggle with mental health issues, including anxiety and depression.
  • Training college students in effective strategies for helping a friend struggling with mental health issues may increase help-seeking behavior.
  • Students who receive training show stronger intention to intervene if they recognize a friend is struggling with suicidal thoughts..
  • Students who receive training in how to intervene effectively show greater confidence in their ability to do so.

Co-authored by Tommy Mobley and Katie Siegel

In the fall of 2018, Tommy Mobley was in his college dining hall when he noticed a classmate, seemingly struggling, sitting alone, staring down at the floor. His slouched shoulders and exhausted expression concerned Tommy.

I wanted to go over to him and ask him if he was okay and see if I could help him. But then I thought, what if I’m misreading his body language, what if he’d feel embarrassed if I approached him, or if there isn’t anything I could do to help him. So, I didn’t say anything. I just picked up my plate and walked away.

A few weeks later, Tommy learned that this classmate had taken his own life. “To this day, I cannot shake the memory that I never said anything,” Tommy said.

Tommy’s experience and decision making are actually quite common for college students. Whenever students walk into their dining hall, they are likely to encounter several classmates struggling with anxiety or depression.

A 2019 survey conducted by the American College Health Association found that despite 66% of students reporting overwhelming anxiety in the past 12 months, only 24% received treatment for their anxiety, and even though 45% of students reported severe depression, only 20% of students received treatment for it. Untreated anxiety and depression can often lead to self-harm, as the survey also found that over 13% of students reported that they “seriously considered suicide” in the past year.

However, this survey also found some promising news. Among students that seek help for their mental health, most initially did so after being encouraged by a friend. The college environment is ideal for students to recognize when a friend needs help: students eat together, study together, and even sleep in the same dorm rooms together, so why don’t students always speak up when they are concerned about a friend?

Like Tommy, many students are afraid to speak up because they do not know the signs of mental health concerns, fear how their friend will respond, or lack confidence in their ability to help. This research suggests that the key to increasing help-seeking behavior among college students likely relies on students’ willingness and ability to speak up when they worry a friend needs help.

Julia Larson/Pexels
Source: Julia Larson/Pexels

It’s not uncommon for students to receive bystander training for sexual assault or risky drinking issues. On many university campuses, these programs have had great success. So why not mental health training?

This question inspired our current research, in which we designed and compared three brief interventions: a self-efficacy intervention providing training in specific skills to take action; a misperceptions intervention correcting commonly held false beliefs about intervening; and an empathetic listening control providing neutral but relevant information about responding to a peer. All interventions were 15-minutes long, web-based, and included information about mental health on campus, as well as signs that a peer is struggling. Here are our key findings:

 

Misperceptions Matter

Misperceptions, which are false interpretations often rooted in social norms, are a key contributor to the decision to intervene when a friend is struggling. Regarding mental health, one common misperception held by peers is the belief that asking a friend about suicidal feelings will make the situation worse.

In a study surveying mental health professionals, adolescents, and parents on different intervention strategies, the greatest discrepancy in response were on this exact topic. Professionals indicated that speaking openly about suicidal thoughts was more helpful than harmful, whereas nonprofessionals believed the opposite.

We sought to alter such perceptions in our misperceptions intervention by identifying and correcting commonly held false beliefs about intervening. In one section, participants were shown the belief; “If a friend needed help, they would know where to find it,” followed by a “reality;” peers play an important role in reducing stigma surrounding help-seeking and disseminating resources. After completing this 15-minute activity, we saw a lasting impact.

When we surveyed students three months later, they displayed higher moral courage (the intention to do the “right” thing, regardless of outcome). They were less likely to let the fear of hurting their friendship prevent them from intervening. Men and upper-level students were better at recognizing a need for action, and upper-class women had higher empathy.

Self-Efficacy Generates Action

Confidence in one’s ability to accomplish a certain task called self-efficacy is another crucial component in deciding to intervene when a friend is struggling. A student with low self-efficacy may recognize signs of poor mental health among peers but feel they are not equipped to get involved.

In our self-efficacy intervention, we sought to improve students’ skill set by providing concrete ways to intervene effectively. As part of a letter-writing exercise, we also asked students to write to a first-year, sharing these strategies.

Three months later, students in this intervention were less likely to let the fear of hurting their friendship prevent them from intervening. Future interventions should consider adding an actual practice component to solidify these skills further.

 

KEY POINTS

  • Many college students struggle with mental health issues, including anxiety and depression.
  • Training college students in effective strategies for helping a friend struggling with mental health issues may increase help-seeking behavior.
  • Students who receive training show stronger intention to intervene if they recognize a friend is struggling with suicidal thoughts..
  • Students who receive training in how to intervene effectively show greater confidence in their ability to do so.

Co-authored by Tommy Mobley and Katie Siegel

In the fall of 2018, Tommy Mobley was in his college dining hall when he noticed a classmate, seemingly struggling, sitting alone, staring down at the floor. His slouched shoulders and exhausted expression concerned Tommy.

I wanted to go over to him and ask him if he was okay and see if I could help him. But then I thought, what if I’m misreading his body language, what if he’d feel embarrassed if I approached him, or if there isn’t anything I could do to help him. So, I didn’t say anything. I just picked up my plate and walked away.

A few weeks later, Tommy learned that this classmate had taken his own life. “To this day, I cannot shake the memory that I never said anything,” Tommy said.

Tommy’s experience and decision making are actually quite common for college students. Whenever students walk into their dining hall, they are likely to encounter several classmates struggling with anxiety or depression.

A 2019 survey conducted by the American College Health Association found that despite 66% of students reporting overwhelming anxiety in the past 12 months, only 24% received treatment for their anxiety, and even though 45% of students reported severe depression, only 20% of students received treatment for it. Untreated anxiety and depression can often lead to self-harm, as the survey also found that over 13% of students reported that they “seriously considered suicide” in the past year.

However, this survey also found some promising news. Among students that seek help for their mental health, most initially did so after being encouraged by a friend. The college environment is ideal for students to recognize when a friend needs help: students eat together, study together, and even sleep in the same dorm rooms together, so why don’t students always speak up when they are concerned about a friend?

Like Tommy, many students are afraid to speak up because they do not know the signs of mental health concerns, fear how their friend will respond, or lack confidence in their ability to help. This research suggests that the key to increasing help-seeking behavior among college students likely relies on students’ willingness and ability to speak up when they worry a friend needs help.

Julia Larson/Pexels
Source: Julia Larson/Pexels

It’s not uncommon for students to receive bystander training for sexual assault or risky drinking issues. On many university campuses, these programs have had great success. So why not mental health training?

This question inspired our current research, in which we designed and compared three brief interventions: a self-efficacy intervention providing training in specific skills to take action; a misperceptions intervention correcting commonly held false beliefs about intervening; and an empathetic listening control providing neutral but relevant information about responding to a peer. All interventions were 15-minutes long, web-based, and included information about mental health on campus, as well as signs that a peer is struggling. Here are our key findings:

Misperceptions Matter

Misperceptions, which are false interpretations often rooted in social norms, are a key contributor to the decision to intervene when a friend is struggling. Regarding mental health, one common misperception held by peers is the belief that asking a friend about suicidal feelings will make the situation worse.

In a study surveying mental health professionals, adolescents, and parents on different intervention strategies, the greatest discrepancy in response were on this exact topic. Professionals indicated that speaking openly about suicidal thoughts was more helpful than harmful, whereas nonprofessionals believed the opposite.

We sought to alter such perceptions in our misperceptions intervention by identifying and correcting commonly held false beliefs about intervening. In one section, participants were shown the belief; “If a friend needed help, they would know where to find it,” followed by a “reality;” peers play an important role in reducing stigma surrounding help-seeking and disseminating resources. After completing this 15-minute activity, we saw a lasting impact.

When we surveyed students three months later, they displayed higher moral courage (the intention to do the “right” thing, regardless of outcome). They were less likely to let the fear of hurting their friendship prevent them from intervening. Men and upper-level students were better at recognizing a need for action, and upper-class women had higher empathy.

Self-Efficacy Generates Action

Confidence in one’s ability to accomplish a certain task called self-efficacy is another crucial component in deciding to intervene when a friend is struggling. A student with low self-efficacy may recognize signs of poor mental health among peers but feel they are not equipped to get involved.

In our self-efficacy intervention, we sought to improve students’ skill set by providing concrete ways to intervene effectively. As part of a letter-writing exercise, we also asked students to write to a first-year, sharing these strategies.

Three months later, students in this intervention were less likely to let the fear of hurting their friendship prevent them from intervening. Future interventions should consider adding an actual practice component to solidify these skills further.

Liza Summer/Pexels
Source: Liza Summer/Pexels

Main Take-Aways

With the high prevalence of mental health disorders on college campuses, it is paramount that students feel confident to speak up when they believe they should do so. Schools should provide students with training to equip them with the knowledge and skills to intervene when a peer is struggling with their mental health. Based on our findings, brief web-based interventions are a promising platform by which to do this.

Remember, if you or someone you know is in crisis or in need of immediate help call 1-800-273-TALK (8255). This is the National Suicide Prevention Lifeline, a free hotline available 24 hours a day.

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