Residential Life Counseling & Wellness

Exciting. Anxiety-provoking. Feeling free. Feeling homesick. These are just a few words and phrases that might describe your experience as you transition to college life here at SF State, whether you are a freshman, transfer student, international student, or living on-campus for the first time. For some students, their expectations of college life have been met; for others, not so much. With any large change like a move to college or to living on-campus, there is going to be stress and various emotions like sadness, loneliness, and worry. These are common reactions and it is important if you’re having these to remind yourself that your may just be overwhelmed. However, there are some helpful tips that can support you during this major life transition:

What changes are common when I come to SF State and live in the Res Life community?

• Experiencing a new environment and new relationships: Life on-campus is different than living at home or off-campus. Residents have to adapt to a new and unfamiliar environment, different living arrangements, and new roommate relationships. You likely will have to adjust to roommates from various cultural backgrounds and who have different values around boundaries, privacy, and communication. Sometimes roommate relationships develop into friendships; other times they do not. What is true about all of these situations, however, is that you have a unique opportunity to learn about yourself and others, which can lead to personal growth and development.

• Feeling the sense of greater personal independence and freedom: Living on your own means you will have more opportunities to make your own decisions about many areas of your life. This can be exciting, and it can also be overwhelming. Whatever feeling this brings up for you, remember to be patient with yourself, as this is a learning process. You will make mistakes along the way; that is common. But you will also begin to take control over many aspects of your life, and that can be really satisfying.

• Feeling that you have more responsibility now than before: In addition to having more independence and freedom, residents also face a realization that they have more daily responsibilities to manage (such as eating regularly, getting enough sleep and maintaining their health, socializing when there is time, and participating in campus activities and clubs). They also realize that they often must take the initiative to address those responsibilities (like paying housing bills, monitoring their meal plans, scheduling classes, or asking RAs or staff for help when it’s needed). This can feel empowering, and it can also feel overwhelming. Whatever your reaction is to having more responsibility, remember that there is help from residential life. Just talk to your RA, area coordinator, or the clinical counselor. They’re all here to help you adjust during this transition.

• Experiencing changes in relationships: Residents often experience changes in relationships with family, friends, and partners who they have known before coming to live on-campus. This can be unsettling, especially in light of new relationships that are forming since coming to college. Acknowledging and communicating your feelings about the changes in your relationships can be a starting point for making sure you don’t lose those important people in your life. Often this can mean making sure you keep in touch with people who are important to you, either through email, video chat, phone, or even the old-fashioned way: by writing a letter. Just remember: whether you’re feeling closer or more distant, sad or happier about the old and new relationships in your life, a wide range of reactions is common and you can deal with them. Talk to someone (your roommate, friend, RA or the counselor). They can provide support and some helpful guidance as you juggle these changing relationships in your life.

What stressors might I face when I come to SF State and live in the residential community?

• Time management issues: One of the most common challenges new residents experience involves managing time. With greater independence, freedom and responsibility, as well as old relationships shifting and new relationships forming, managing time between academic, personal and sometimes work-related obligations can be tricky. Even classes require more work often outside of rather then in class. (For example, you likely will spend less time in the classroom then studying in the library or your room). These changes require special attention in terms of how you manage your time. At times, you may even feel like you don’t have enough time for everything! This is common. Don’t freak out! Start with some basic strategies for time management: keep a planner that lists your daily, weekly, and semester obligations (test dates, paper deadlines, group project deadlines, etc.). Also, break larger tasks into smaller ones so that you’re consistently working towards your goal of finishing a task (whether it’s an academic or even work-related task). And reward yourself when you reach your goal.

• Academics: Probably one of the most common stressors for residents involves academics. And of course this makes sense! You are a student, after all, and you are working hard to learn a great amount of new information. By its very nature, college academic work is challenging. Some residents experience pressure within themselves and from their parents. While it is important to do the basic things like attending class regularly, keeping up with your reading, and doing your assignments as early as you can before they are due, you can also access campus support regarding your academics. Speak with your professors, seek out support at your department, contact a tutor, or even reach out to a program like the Student Success Program in HSS 254 for peer support.

• Roommate conflict: It's not unheard of for roommates to disagree or even not get along some of the time. You might have hoped that you and your roommate would turn out to be good friends, and that may not have turned out to be the case. Whatever the circumstance, there are some important tips that can be helpful to ease you and your roommates through conflicts. First, if possible, set up communication from the get-go: have a roommate meeting when you first move in together to discuss household issues like how late music can be played, who is responsible for cleaning the apartment, and guidelines for having guests over. Second, talk with each other on the best way to handle disagreements. That might include setting a monthly check-in meeting to see how things are going. Third, make a commitment to listen to each other when something isn’t working. Listening before responding is the key here. When we are not listening and simply responding, we are often perceived as being defensive, and that often does not lead to resolution. Fourth, address situations as they arise. Be respectful when you bring up concerns and choose your language wisely. Finally, learn how to compromise. We all have to compromise. Decide what you’re willing to give up, and what your absolute bottom line is. It has to be a give and take process for everyone to feel like their feelings were respected and heard.

What recommendations are there that could help me adjust to life at SF State and in the residential community?

• Be patient with yourself! Over time, many of these unsettling reactions will subside as you get used to the new environment, new relationships, and the greater independence and responsibility you are experiencing. Try to establish routines and rituals every day or week that give you a sense of structure to your time here. Also, reach out to resources on-campus for support: your roommate, RA, the counselor, even campus organizations and clubs. The more you put effort into establishing a new and broad social support system, the more stable you will feel.
• Get involved. When you start to feel down and see that you are beginning to isolate or withdraw, this is exactly the time to set a goal of reaching out to others: a new friend, roommate, or a campus organization or club. It can’t be stated enough: the more you put your time and energy into establishing a support system here, the less you will be focused on the unsettling feelings you have because you are not at home.
• Use the resources available to you. SF State has a vast array of resources. We are a community of over 30,000 students, staff and faculty. People are here to help when you’re feeling lost. See the list of resources at the start of this Health and Wellness section on the website. Any of them can be of assistance. Just give them a call, or stop by their office.
• Take care of yourself. This is perhaps one of the most important recommendations to follow. Remember to eat and sleep regularly, take care of your health, exercise regularly, and reach out to your social supports on-campus, off-campus, and at home. The more balance you have in your life, the easier it will be to manage those times when distressing feelings or situations arise. You will be ready to tackle those moments if you have taken care of yourself before those moments arise.

Everyone knows what it's like to feel anxious: the butterflies in your stomach before a first date, the tension in your shoulders when your boss criticizes you, or the way your heart pounds if you feel you're in danger. Anxiety is actually a warning signal for us. It can alert us to take action, especially if we're in threatening situations. It might make us study harder for exams or keep us on our toes when speaking in public. In general, it helps us to cope.

But what exactly is anxiety?

Anxiety is generally a feeling of uneasiness, apprehension, or tension that someone feels in response to stressful or threatening circumstances. Some people feel more anxiety than others. It can be mild or so intense that someone feels panic. Typically, anxiety is temporary. But when it lasts a long time or occurs at times when there is no stress or threat present, this normally helpful emotion can be considered a problem. No longer do you have just a case of the "nerves." You might have an illness that needs treatment and support.

Facts and statistics about anxiety

Here are some facts and statistics about anxiety:

• Anxiety illnesses are the most common emotional illnesses in the U.S.
• More than 18 million Americans are affected by anxiety illnesses.
• Anxiety illnesses cost the U.S. over $50 billion dollars to treat annually in the U.S. and are nearly one-third of the nation's total mental health bill.

Symptoms of anxiety

In general, there are both physical and psychological symptoms of anxiety. Psychological symptoms include:

• Agitation
• Difficulty concentrating
• Distress
• Fear
• Impatience
• Inability to relax
• Irritability
• Panic
• Racing thoughts
• Restlessness
• Trouble sleeping
• Uneasiness
• Worry

Physical signs and symptoms include:

• Choking sensation
• Constipation
• Diarrhea
• Dry mouth
• Faintness
• Frequent urination
• Hyperactivity
• Hyperventilation
• Lightheadedness
• Muscle tension
• Nausea/vomiting
• Perspiration/warming of the skin
• Rapid or irregular heartbeat
• Shortness of breath
• Sweating, often in the palms
• Tingling
• Tremors

Types of anxiety illnesses

There are at least five general categories of anxiety and a sixth type of anxiety common for many college students: test anxiety.

Generalized anxiety

"I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for dinner, or what would be a great present for somebody. I just couldn't let something go."

Generalized anxiety is much more than the common anxiety people experience day to day. It's chronic and exaggerated worry and tension about everyday routine life events and activities that lasts for a period of at least 6 months, even though nothing seems to provoke it. People with generalized anxiety almost always anticipate the worst even though there is little reason to expect it. They can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation requires. They often worry excessively about money, health, family or work. Sometimes the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.

Often people with generalized anxiety have difficulty relaxing or falling or staying asleep. They usually have physical symptoms such as trembling, muscle tension, headaches, irritability, sweating, frequent urination, hot flashes, or nausea. They may feel lightheaded, out of breath, or as though they have a lump in their throat.

Panic

"It started 10 years ago. I was sitting in a class and this thing came out of the clear blue. I felt like I was dying. It was almost like a violent experience. I felt like I was going insane and losing control. My heart pounded really hard and there was this strong feeling of impending doom. After that, I began to worry that it was going to happen again, and that made things even worse."

People who experience panic attacks have feelings of terror, intense fear and an impending sense of danger that strike suddenly and repeatedly with no warning. They may have thoughts of doom or a fear of dying or of going insane. Physical symptoms such as dizziness or shortness of breath can occur, and the buildup of these symptoms can peak within several seconds to 10 minutes from when they begin.

In addition, because they can't predict when a panic attack will occur, those who suffer from panic attacks can develop intense anxiety between each attack, worrying when and where the next one will happen. They may also have a fear of being in places that might trigger an attack. Because of this, some people's lives become greatly restricted: they may avoid normal, everyday activities or they may only go into certain places or situations if they ask a trusted person to go with them. Because of the intensity of the experience of panic attacks, some people develop depression or cope through alcohol or other drug use.

The cause of panic attacks is not known, but it often runs in families. Also, the buildup of stress, traumatic events from the past, or heavy drug use (marijuana, stimulants, or caffeine) can result in panic symptoms.

So what are the symptoms of panic? They can include the following:

• Accelerated heart rate
• Chest pain
• Dizziness
• Faintness
• Fears of losing control, dying, or going insane
• Hot or cold flashes
• Nausea/queasy stomach
• Pacing
• Shaking or trembling
• Shortness of breath
• Sweating
• Thoughts of being in danger and feeling unable to cope
• Tingling or numbness

Panic attacks strike between three and six million people in the U.S. It is twice as common in women as in men. It can appear at any age, but most often it begins in young adults like many students on our campus.

Phobias

"My fear would happen in any social situation. I would be anxious before I even left the house, and it would escalate as I got closer to class, a party, or whatever. I would feel sick to my stomach. It almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else."

A phobia is a fear of a specific object, activity or situation that is so strong that you avoid anything that triggers your fear. It is different from ordinary, everyday fears because it causes you to stop doing things you used to enjoy doing. When the fear hits, the person can experience his or her heart racing, have difficulty breathing, and may tremble and sweat. There are 2 types of phobias: social phobia and specific phobia.

Social phobia is an intense fear of becoming humiliated or embarrassed in situations involving other people. Social phobia often begins in adolescence when teenagers fear being seen as weak, "crazy," or stupid. Small mistakes may seem much more exaggerated than they really are. Blushing may feel embarrassing. The person with a social phobia often feels as if all eyes are focused on her or him. The most common social phobia is a fear of public speaking, although it at times involves a general fear of social situations such as parties or eating out.

People with specific phobias experience extreme, disabling and irrational fears of certain things or situations such as closed-in places, heights, escalators, tunnels, bridges, flying, and water. These fears can lead to distress, panic, and avoidance of these things or situations that frighten the person. Specific phobias strike more than 1 in 10 people, seem to run in families, occur slightly more often in women than men, and usually first appear in adolescence or young adulthood.

Post-traumatic stress

"I was raped when I was 20 years old. For a long time, I spoke about it on an intellectual level, as though it was something that happened to someone else. Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly, I was reliving the rape. Every instant was startling. I felt like my entire head was moving a bit, shaking, but that wasn't so at all. I would get dry mouth and my breathing changed. I felt like I was held in suspension, like in a bubble. It was really scary."

Post-traumatic stress is a reaction someone has to a terrifying event, such as a rape or assault, war, child abuse, natural disasters, or life-threatening accidents. Someone with post-traumatic stress may relive the event by having unwanted flashbacks, nightmares, or sudden intense emotions such as being startled easily, being irritable or angry easily, or being aggressive. Often anniversaries of the event are difficult and can trigger these emotional reactions.

Post-traumatic stress can also lead people to shut off the outside world. They may avoid reminders of the terrifying event that happened to them, including certain people, places or activities. They may forget all or part of the event and the details of the event. They may grow numb emotionally, especially to those around them who they were once close to. They may also lose hope for the future.

Post-traumatic stress can occur at any age. The symptoms can be mild or severe, although the symptoms seem to be worse if the event that triggered them was initiated by a person, such as a rape. Not everyone who experiences a traumatic event will develop post-traumatic stress. Some people recover within several months, while others have symptoms that can last for years. Often, symptoms may not show up until years after the traumatic event.

Obsessive compulsive syndrome

"I couldn't do anything without rituals. They were part of every aspect of my life. Counting was big for me. When I set my alarm at night, I had to set it to a number that wouldn't add up to a "bad" number. I would wash my hair three times instead of once because three was a good number and one wasn't. I was always worried that if I didn't do something, my parents were going to die. Or I would worry about harming my parents, which was completely irrational. I knew these rituals and routines didn't make sense, but I couldn't seem to overcome them."

People with obsessive compulsive syndrome or disorder (OCD) often have repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control. Someone may be obsessed with germs or dirt so she washes her hands over and over. Another person with OCD may be preoccupied with doubt about having done something, such as turning off the stove or locking the door, so he may check repeatedly to make sure that action was completed. Still someone else with OCD may have the worry that he will do something violent or inappropriate and therefore spend long periods of time touching things, counting or are preoccupied by order or symmetry to calm his worries.

The disturbing thoughts or images that are part of OCD are called obsessions and the rituals that are performed to try to prevent or get rid of the thoughts are called compulsions. There is no pleasure in carrying out the rituals, only temporary relief caused by the obsession.

Many people can identify with having some of the symptoms of OCD, but to have a diagnosis of this syndrome, the compulsions should last at least an hour a day, are very distressing, and interfere with daily life. Most people with the syndrome recognize what they're doing doesn't make sense, but they can't stop it.

Both men and women are affected in equal numbers by OCD. It can appear in childhood, adolescence, or adulthood, but on the average it shows up in teen years or early adulthood.

Test anxiety

"I don't know why it happens, but before every exam I get incredibly anxious. It actually starts when I'm studying for the exam. It can get so that it affects my focus when I'm studying, the way that I understand the questions on the test, and even my ability to remember things that I know I had memorized."

Test anxiety is a type of "situational anxiety" or "anticipatory anxiety" that occurs while taking or preparing to take an exam. While some anxiety is natural to keep you mentally and physically alert, text anxiety causes physical distress, emotional upset, and concentration difficulties.

People who experience test anxiety can experience rapid heart rate, muscle tension, queasiness, dry mouth, or perspiration. They may find it hard to make decisions, express themselves, read or understand questions, organize thoughts, or retrieve key words and concepts. For some people, they may even have the experience of going blank on questions and then remembering the answers after the exam is over.

Several things can lead to test anxiety, including past experiences of blanking out on tests or being unable to retrieve answers to questions on an exam. It also can result from negative thinking and worries, such as focusing on past poor performances on exams, how friends and other classmates are doing on the exams, or the negative consequences someone expects will happen if she does poorly on the exam.

Treating anxiety

There are several different types of treatment for anxiety. Some treatments can help with certain types of anxiety, while other treatments are geared for the specific type of anxiety someone is facing. For example, one of the first things anyone should do is check with their doctor to make sure their anxiety is not due to a medical condition. In addition, lifestyle changes can help almost anyone with anxiety symptoms. Such changes can be getting enough sleep each night; exercise; decreasing caffeine, alcohol or other substance intake; changing eating habits that might include decreasing sugar intake; talking more regularly with a trusted friend or family member; and increasing relaxing and self-soothing activities.

Therapy is also an effective way to treat anxiety. By meeting with a counselor, someone with anxiety can learn to replace anxious or compulsive thoughts and actions with positive, rational ones. She can also gradually learn new coping skills such as controlled breathing, muscle relaxation, meditation, visualization (where someone imagines a calming, soothing scene or person to decrease their anxiety), or other relaxation strategies. The therapy can also be a place where the anxious person works on expressing feelings which can have the effect of reducing anxiety symptoms.

Medication in some instances can also be effective in treating anxiety. In most cases, medication works best in conjunction with therapy. When medication is advised for anxiety, it must be prescribed by a doctor who has assessed the symptoms and determined which medication is best.

Perhaps one of the most important things to know about treating anxiety is that it can take some time before one sees the benefits from the specific type of treatment. The main point for people with anxiety to remember is to be patient, keep practicing the skills they are learning, and take notice of the small steps of progress they are making as they treat their anxiety.

As always, for any range of emotional issues you may be struggling with, contact the Counseling and Psychological Services Center at (415) 338-2208 for support.

On-Campus

The Counseling and Psychological Services Center (CPSC)

At SF State, you also have access to brief counseling through Counseling & Psychological Services located in the Student Services Building, Room 208 (SSB 208). Licensed counselors are available to you for individual, couples, and group counseling, as well as mental health education. To make an appointment visit the C&PS office in SSB 208. For urgent appointments, drop-in spots are available. For emergencies outside regular business hours and on weekends, contact University Police at (415) 338-2222. Services are free and confidential.

Student Health Services (SHS)

The Student Health Services (SHS) is available to all students for health related and urgent mental health issues. The SHS provides comprehensive preventative health, primary care services and pharmacy services as well as psychiatric services.

Active Minds

Active Minds at SF State is a part of a nationally recognized organization, Active Minds, Inc., that exists as a student-run mental health awareness, education, and advocacy organization on the college campus. By promoting awareness and education, the group aims to remove the stigma that surrounds mental disorders and create and open environment for discussion of mental health issues. The organization targets the entire college community through large-scale educational campaigns and events such as panel discussions, movie screenings, and benefit runs.

Off-Campus

Community Psychiatry

Community Psychiatry is a group of private practice psychiatry offices throughout Northern California. Community Psychiatry has relationships with psychiatrists, therapists, and other mental health professionals who accept a range of health insurance plans. All it takes is a call to Community Psychiatry to get linked to a professional on your insurance plan for an evaluation and treatment recommendation.

Half of Us

Half of Us is a website devoted to raising awareness about the prevalence of mental health issues on campuses and to connecting students to the appropriate resources to get help. Video stories of people who have struggled and overcome mental health issues are available for viewing, as well as information about mental illness and resources for support.

Know the Signs

Know the Signs is a statewide suicide prevention social marketing campaign built on three key messages: Know the signs. Find the words. Reach out. This campaign is intended to educate Californians how to recognize the warning signs of suicide, how to find the words to have a direct conversation with someone in crisis and where to find professional help and resources.

The JED Foundation

The JED Foundation is a national foundation working to reduce emotional distress and prevent suicide among college and university students. The organization works to increase understanding about the prevalence of and the warning signs and symptoms of suicide and other emotional disorders.

Depression occurs when someone's mood is characterized by a number of feelings, including sadness, disappointment, loneliness, hopelessness, self-doubt, and guilt. Many people feel depressed at some point in their lives, but often they can revive and rejuvenate themselves and return to a more upbeat mood. Some people, though, can experience depression more frequently, for a longer period of time, or more intensely. In these instances, daily activities become difficult. Sometimes hopelessness increases to the point of thinking about suicide. In these instances, talking to a counselor is recommended for support and advice on how to relieve the symptoms and return to a more fulfilling and active state of mind.

So what are the symptoms of depression?

There are several signs and symptoms of depression, including the following:

Changes in feelings:

• Difficulty finding pleasure in anything
• Feeling hopeless or worthless
• Feeling guilt or self-blame

Changes in behaviors and attitudes:

• Lack of interest in things you used to do
• Withdrawal from others
• Irritability
• Dissatisfaction with life in general
• Difficulty concentrating, making decisions, and remembering things

Changes in physical complaints:

• Chronic fatigue
• Lack of energy
• Loss of appetite, or over-eating
• Insomnia or excessive sleeping
• Digestive problems, including stomach pain, nausea, indigestion
• Unexplained headaches or backaches

What causes depression?

Depression may be caused by psychological, biological or genetic factors. It also may result from negative life events or drug or alcohol use. When a person can identify the source of the depression, that individual can often use familiar coping strategies to move through the depression. If, however, the cause of the depression is unclear and the individual's familiar coping strategies do not work to reduce the depression, the symptoms can intensify and last longer.

Who can you turn to for help for depression?

There are ways to address depression. Sometimes, you can take steps to improve your mood. You can talk about your problems and your symptoms with someone you trust. Talking can help externalize your feelings so they are not all bottled up inside. You can switch up your normal routine and do a favorite activity you haven't done in awhile. You can exercise to reduce tension, improve your digestion, help you relax, and maybe improve your sleep. And you can avoid things that add stress to your life.

Sometimes, seeing a professional can be helpful to address depression. That can be your doctor, a counselor or therapist, or a psychiatrist. Mental health professionals can help identify possible causes of depression and make recommendations about the best way to treat your depression. On-campus, you can call the Counseling and Psychological Services Center at (415) 338-2208 for professional guidance regarding your depression.

Grief is an emotional reaction that follows the loss of someone or something of great value. It is a spiral of feelings and reactions rather than a line with a beginning and an end. In a sense, grief doesn't know the concept of time. Sometimes it can feel like the loss happened yesterday although it may have happened awhile ago.

Losses that can cause grief

Most people think of grief connected to the death of a loved one, but there are actually many life changes that can lead to feelings of grief and loss. Some examples include:

• Relationship changes, such as the ending of a friendship, dating relationship, or a break in a family relationship. This can include parents divorcing or separating, as well as changes in a friendship in your life.
• School or job-related changes, such as graduation, moving to a new place, losing out on a new career opportunity or internship.
• Health changes, such as an injury or illness that is chronic and not easily resolved, or changes in a family member's health.
• Life changes that include the death of a friend, partner, or family member.

The stages of grief

Research has identified certain stages of grief reactions that many people experience. It is important to know, however, that these stages occur differently for each person. They may not occur in sequential order, but the emotions that are linked to the stages are common emotions that people experience at some point in the grieving process.

When a loss occurs, it is important to recognize that this loss has happened. However, many people initially experience shock or disbelief which can last for days or weeks. It is almost as if people are in a state of denial about the loss or as if they are acting on "auto pilot" and restricted from feeling the full impact of the loss. People can also feel angry, numb, confused about what happened, or even guilty.

At some point after recognizing that a loss has occurred, a person can begin to feel more intense emotions, including tearfulness and crying; feeling anxious and overwhelmed; preoccupation with the loss or memories of the lost person or situation; feeling restless or having difficulty sleeping; feeling anguish, agony, despair; and physical symptoms including headaches, fatigue, or upset stomach. All of these reactions are common, as the reality of the loss settles in.

Healing from a loss takes time, and it varies for each person. Signs that someone is moving towards the end of the grief process include feeling more energized; experiencing bursts of energy and building an interest in life again; and beginning to make plans for the future.

It is important to know that some of the feelings described above can reoccur during anniversaries of the date of the loss, birthdays or other significant events that can happen annually or throughout a year that remind you of the loss, or other triggering situations or events. Preparing ahead of time before these anniversaries occur can be very helpful. You can make sure to be with someone to talk about the loss before or on an anniversary, or do something significant to honor the loss at that time. Whatever you do, remembering not to deny that these feelings may come up due to memories of the loss is critical.

Ways of coping with grief

Different strategies can be helpful to cope with feelings of grief. These strategies are helpful in accepting the reality of the loss, working through the denial of the loss to the feelings of pain and grief, adjusting to life with an acknowledgment of the loss, and reinvesting in a future after the loss. Here are some things that can be helpful with all of those tasks:

• Talk about the loss with friends or relatives. Getting their support can be invaluable. Sometimes, meeting with a counselor can be helpful if you cannot identify someone you feel comfortable talking to or if you feel you reaction is interfering too much with your daily living.
• Create a ritual to honor the loss. This can be a funeral in the case of a death, or it can be creating a photograph memory book. It can also be planting a tree, doing something artistic or creative, or writing a letter to the deceased person or the person with whom you have broken up, without feeling the letter has to be mailed or given to the person.
• Start a journal and write down your feelings about the loss.
• Pray or meet with someone important from your spiritual or religious practice.
• Attend a support group for people who have lost someone to help you feel that you are not alone in this process through which you are going.
• Take care of yourself, including eating regularly, getting enough sleep each night, exercising if you can, and any other self-soothing activities that you know are helpful to you.

Above all else, remind yourself that loss and feelings of grief are unavoidable and common aspects of living. With time, patience, and support, you can move through the grieving process and come to a place in your life with new understandings about you, others in your life, your spirituality, and life overall.

https://caps.sfsu.edu – The SF State Counseling & Psychological Services website containing Wellness Tips, on and off-campus resources, and emergency information

www.jedfoundation.org – The JED Foundation is one of the nation?s leading organizations working to reduce emotional distress and suicide among college students

www.ulifeline.org – An online resource for college mental health

www.halfofus.com – An online project with mtvU that includes videos of students? favorite artists and other students sharing how they have coped with mental health issues

www.mentalhelp.net – A website dedicated to promoting mental health and wellness education and advocacy

www.nimh.nih.gov – An online service with mental health educational and research materials

Along with depression can come feelings of suicide. Sometimes we hear about suicide because we know someone who has thought of ending his or her life. At times we may even have thoughts of ending our own lives. The writer William Styron in his book Darkness Visible described the pain and agony connected to suicide in this way: "For myself, the pain is most closely connected to drowning or suffocation . . . but even those images are off the mark." So what are the facts about suicide, and what can you do if you are feeling suicidal or know someone who is?

General facts and information about suicide

Here are important facts about suicide:

• In 2003, 31,484 people in the U.S. died by suicide and an estimated 787,000 people in the U.S. attempted suicide.
• 24% of the general population has considered suicide at some point in their lives.
• Suicide is the second leading cause of death among 20 to 24-year olds and 1 in 12 college students in the U.S. makes a suicide plan.
• 70% of people who commit suicide tell someone about it in advance and nearly 50% of suicide victims had a positive blood alcohol level.
• Between 20 and 40 percent of people who kill themselves have previously attempted suicide.

And here is some more information about suicide:

• More students under 21 seriously considered or attempted suicide compared with those over the age of 22.
• More female than male students report having considered suicide one or two times, but more males than females report having considered it three or four times.
• More white students than African Americans, Asians and Latinos report being depressed, yet more Asian and Latino students than whites report seriously considering suicide.
• People who have made serious suicide attempts in the past are at a much higher risk for actually taking their lives in future attempts.
• Each suicide death affects at least 6 other people.

Reasons people attempt or complete suicide

There can be any number of reasons people attempt or complete suicide. The primary reason is when people feel depressed, hopeless, and are in such emotional anguish that they feel suicide is the only form of relief. Also, for those students who enter college with a history of mental health problems or develop mental health problems during college, there is a higher risk for suicide. Additionally, people may feel a sense of failure or exhaustion and their coping skills are no longer working. These students may think about suicide as a way to free themselves from their growing emotional discomfort and pain.

Warning signs of suicide

There are several things that indicate whether you or someone you know is serious about ending your life. Here are some of the warning signs of suicide:

• Appearing depressed or sad most of the time. (Untreated depression is the number one cause for suicide.
• Feeling hopeless or expressing hopelessness
• Withdrawing from family and friends
• Sleeping too much or too little
• Feeling tired most of the time
• Gaining or losing a significant amount of weight
• Making statements such as these:
  • "I can't go on any longer."
  • "I hate this life."
  • "There's no point to this stupid life."
  • "Everyone would be better off without me."
  • "Life is not worth living."
  • "Nothing matters anymore."
  • "I don't care about anything anymore."
  • "I want to die."
  • And any mention of suicide
• Writing notes or poems about suicide or death
• Acting compulsively
• Losing interest in most activities
• Giving away prized possessions
• Writing a will
• Facing a perceived "humiliating" situation or "failure"
• Feeling excessive guilt or shame
• Acting irrationally
• Being preoccupied with death or dying
• Behaving recklessly
• Irritability
• Neglecting personal appearance or a dramatic change in personal appearance or in personality
• Abusing alcohol or drugs

If you are someone experiencing these warning signs, it does not necessarily mean that suicide is imminent. Those at risk for suicide often are people who have a history of suicide attempts; a family history of suicide; ongoing feelings of hopelessness, guilt, anger, or sadness; and/or a preoccupation with death. However, if the above mentioned items describe your feelings or your history (or the feelings or history of someone you know), you should check in (or have the other person check in) with a counselor to talk about what is going on in your life that is leading to these symptoms. Assistance is available at the Counseling and Psychological Services Center at (415) 338-2208, the Student Health Center at (415) 338-1251, or for immediate emergency support, the University Police at (415) 338-2222.

What can you do if you know someone who is depressed and think they might be suicidal?

To support someone you know is depressed and might be suicidal, here are three steps that you can take:

• Step one – Show you care: Be a good listener and be patient. Take discussions about suicide seriously. Don't be judgmental or tell someone that they "shouldn't" be thinking about suicide. Do tell someone that you're concerned about them; that you want to hear about their problems; that you want to help; that you care about them; and that you don't want them to kill themselves.
• Step two – Ask about suicide: Directly ask someone, "Have you been thinking about suicide?", "Have you thought how you would do it?" and "How close have you come to ending your life?" This will give you important information in terms of the support you recommend for them.
• Step three – Get help: Avoid leaving the person alone if you can. Offer to help the person get engaged. Refer them to the Counseling and Psychological Services Center or University Police, and escort them there if needed. Also, it's important that you don't keep this information to yourself. Let your RA or someone else in Residential Life know of this issue.