Mental Health
Red Folder Guide
A guide for recognizing, responding to and referring distressed students.

About the Red Folder
The “Red Folder” guide was produced by Penn State’s Student Affairs/Counseling and Psychological Services and Commonwealth Fee Board, and updated with Hershey-specific information by the Office for Professional Mental Health at Penn State College of Medicine.
The folder is a quick-reference guide to help faculty and staff recognize, respond to and refer distressed students. You can also download this resource as a PDF from OneDrive to print it out (updated June 21, 2019).
How to Use the Guide
Recognize indicators of distress
Common indicators are listed below. Students may present with indicators not listed.
Respond appropriately
Each situation is unique. Use the tips and decision tree to determine the most appropriate response
Refer the student
Use the list of resources to refer the student to the most appropriate campus resource.
Recognize
Look for groupings, frequency, and severity of behaviors, not just isolated symptoms.
Academics
Sudden decline in quality of work and grades
Frequently missed classes and assignments
Disturbing content in writing or presentations
Classroom disruptions
Consistently seeking personal rather than professional advice
Multiple requests for extensions/special considerations (a change from prior functioning)
Doesn’t respond to repeated requests for contact/meetings
Physical
Marked changes in physical appearance (e.g., poor grooming/hygiene or sudden weight loss/gain)
Strange or bizarre behavior indicating loss of contact with reality
Visibly intoxicated or smelling of alcohol or marijuana
Rapid speech or manic behavior
Depressed or lethargic mood or functioning
Observable signs of injury (e.g., facial bruising or cuts)
Psychological
Self-disclosure of personal distress (e.g., family problems, financial difficulties, assault, discrimination, legal difficulties)
Unusual/disproportionate emotional response to events
Excessive tearfulness, panic reactions
Verbal abuse (e.g., taunting, badgering, intimidation)
Expressions of concern about the student by peers
Safety risk
Verbal, written, or implied references to suicide, homicide, assault or self-injurious behaviors
Unprovoked anger or hostility/physical violence (e.g., shoving, grabbing, assaulting, use of weapon)
Academic assignments dominated by themes of extreme hopelessness, helplessness, isolation, rage, despair, violence, self-injury
Stalking or harassing
Communicating threats/disturbing comments via email, correspondence, texting or phone call
Respond
Use these tips to determine the most appropriate response for a distressed student.
Mandatory reporting: In addition to referring a student to resources, any sexual or gender-based harassment or assault requires mandated reporting. For questions regarding mandated reporting, please contact the Office of Sexual Misconduct Prevention and Response at 814-867-0099.
Stay safe
Call Penn State Police or 911 if there is an imminent danger to the student, you, or anyone else
Stay calm
Take a few deep breaths to calm yourself. Use a calm voice when talking and asking questions.
Take your time
If this is not an imminently dangerous situation, take time to think through what might be the most helpful step.
Seek consultation
You are not alone. Ask those around you for help. Consult with a colleague, call another office on campus (see resources)
Use active listening
Make eye contact, give your full attention. Restate what the student says to make sure you understand what is causing the distress and/or what they are asking for help with.
Ask direct questions
Don’t be afraid to directly ask the student if they are having thoughts of harming themselves or others (by asking, you are not instilling the thought).
Give concrete help
Help get them to the next step (e.g., contact the academic advisor with the student to make an appointment; help them call counseling services to schedule an appointment).
Refer
Follow the steps below to determine who to contact when you are concerned about a student who is distressed and/or disruptive. Emergency and campus resources are listed.
If the student's conduct is clearly dangerous or threatening, including self-harm or harm to others: Call 911 or Penn State Police at 717-531-8888.
If you are not concerned for anyone's immediate safety, but the student is having significant academic and/or personal issues and could use some support: Refer the student to campus resources as appropriate.
If the student is with you currently and shows signs of distress, but it is not clear how serious it is: Call the Office for Professional Mental Health or the Penn State Crisis Line at 877-229-6400. Then, refer the student to appropriate campus resources.
If the student is not with you but you're concerned about what they said OR what they did (acted bizarrely, aggressive or disruptive) OR how they looked (unkempt, unwashed, or drugged/drunk): Report to Campus Safety and Security 717-531-8711 or the Behavioral Threat Management Team.
Resources
Emergency Resources
Campus Safety and Security, 717-531-8888 or 911
Penn State Crisis Line, 1-877-229-6400
24/7 confidential service
Licensed mental health counselors
YMCA/Rape Crisis and Domestic Violence Services, 1-800-654-1211
Off-campus services for victims of sexual and relationship violence and stalking
1101 Market St., Harrisburg, PA 17103
Urgent Resources
Behavioral Threat Management Team, 814-863-2868
Report concerns about any person, including threatening or disruptive behavior
Referrals to support services
Office of Professional Mental Health, 717-531-8658
Crisis, consultation and counseling services
Student Conduct, 717-531-5665
Report possible violations of the Code of Conduct (excludes sexual misconduct — see PMH office for details)
Student Affairs, C1802
Financial Advising, 717-531-7052
C1805, 500 University Dr., Hershey, PA 17033
Additional Resources
Academic advising, 215-881-7328
Medical students, C1802, 717-531-4398
Physician assistant students, CG638B, 717-531-0003, ext. 285595
Graduate students, C1602, 717-531-8892
International student advising, 717-531-4101
Support for international students, including advice on visas and immigration issues
C1802, 500 University Dr., Hershey, PA 17033
Student health, 717-531-5998
C1802, 845 Fishburn Road, Hershey, PA 17033
Diversity/multicultural resources, 717-531-1012
Provides support, advocacy and education for underrepresented populations
Penn State Office of Sexual Misconduct Prevention and Response, 814-867-0099
Report sexual or gender-based harassment or misconduct (e.g., sexual assault, exploitation, stalking, dating/domestic violence)
Investigates concerns; provides resources, support and accommodations to students with disabilities.