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Running head: MENTAL HEALTH ABROAD PROPOSAL

Smooth Journey Abroad:


A Pre-Departure Mental Health Program for UW-Platteville
Samantha Sonkowsky
University of Wisconsin, La Crosse

MENTAL HEALTH ABROAD PROPOSAL

Abstract
This proposal seeks to enhance understanding of mental health issues and how they impact the
study abroad experience for students at the University of Wisconsin Platteville. A component
on mental health will be added to the already established pre-departure programming and a
mental health abroad manual will be developed as a resource for students, faculty, staff, and
education abroad professionals upon implementation of this proposal. Through the development
of this program and resource, UW-Platteville Education Abroad and its host institutions will be
able to better assist students with mental health concerns before, during, and after their study
abroad experience. This proposal addresses the following: (1) description, (2) purpose, (3)
significance, (4) need, (5) stakeholders, (6) learning outcomes, (7) methods of assessment, (8)
phases of implementation, (9) budget, and (10) implications of the new mental health predeparture program and the mental health abroad manual that will be developed.

MENTAL HEALTH ABROAD PROPOSAL

Proposal Narrative
Description of Project
The applied research project will take the form of a pre-departure mental health resource
for UW-Platteville as well as non-Platteville students participating on UW-Platteville Education
Abroad Programs. The resource will also serve as a guide for on-site coordinators and resident
directors at host institutions as reference material. These programs primarily run semester to
academic year and are located in Australia, England, Italy, Fiji, Japan, and Spain. The Education
Abroad staff at UW-Platteville, specifically the Outreach Specialist and the Program
Coordinator, will facilitate the development and implementation of the project. This project will
cover important aspects of student mental health as it relates to the study abroad experience.
Institutional description. Founded in 1866, UW-Platteville is one of the 13 four-year
public institutions within the UW-System. It is well known for its successful engineering,
agricultural, environmental studies, business, and education major tracks and has experienced
record number enrollments over the past few years. With over 40 majors, 76 minors, three
graduate programs, and 17 pre-professional programs (About the University, 2015), UWPlatteville offers a wide range of comprehensive academic coursework. Total enrollment for this
year is estimated to be around 8,900 undergraduate students and approximately 850 graduate
students (2015). UW-Platteville is currently the fastest growing campus within the UW-system,
and has been regionally recognized as one of the best universities in the Midwest for engineering
(2015).
Departmental description. The UW-Platteville Education Abroad Office is part of the
Department of International Programs and the Division of Diversity and Inclusion. The
Education Abroad Office has been offering international education opportunities to UW-

MENTAL HEALTH ABROAD PROPOSAL

Platteville and non-Platteville students for over 75 years (Education Abroad Office, 2015).
Programs range from short-term faculty-led programs to academic year programs. Currently,
UW-Platteville offers over 400 programs in more than 40 countries worldwide. UW-Platteville
is host to six of their own education abroad programs (which are marketed nationally) and has
many faculty-led, exchange and affiliate program opportunities available.
Project contents. The developed resource will provide: (1) useful information in
identifying mental health issues, (2) knowing the warning signs, and (3) provide suggestions
for students, staff, on-site coordinators, and resident directors, both at the home and host
institutions, to efficiently address mental health concerns. Additionally, it will offer students
necessary contact information for: (1) their university counseling services, (2) host institution
services, (3) in-country support, and (4) emergency services. In-country support information
will be primarily available for students on UW-Platteville Education Abroad sponsored programs
in England, Italy, Spain, Japan, Fiji, and Australia. Also, resources related to behavioral health
medications abroad and an in-country directory of English-speaking mental health physicians
will be incorporated into the resource developed as a result of this project.
Project availability. Once the mental health abroad manual is adapted, it will be made
available in various ways. The resource will be made available to all students participating on
UW-Platteville sponsored programs, affiliate, exchange, and short-term faculty led programs.
Students participating in semester or academic year UW-Platteville Education Programs,
exchange, and affiliate program will have the resource delivered to them in person during the
mandatory pre-departure orientation sessions and will receive a printed version of the manual.
Copies will also be made available in the Education Abroad Office, University Counseling
Services, and Disability Services.

MENTAL HEALTH ABROAD PROPOSAL

Project visibility. The Mental Health Pre-Departure Orientation manual will also appear
as learning content material on all students digital application. This will ensure that all students
have some knowledge of mental health abroad and can easily find ways to seek out support
before, during, and after their study abroad experience. Additionally, the resource will appear
under the Health and Safety tab on the UW-Platteville Education Abroad Website. By
providing the resource directly through the website it will ensure access to future and current
students as well as other individuals such as parents, cooperative institutions, and on-site
coordinators for example. Individuals will also have the option or order a copy of the resource
directly from the Education Abroad Office.
Statement of Need
Universities nationwide have reported an increase of students presenting with
psychological disorders and mental health issues in recent years. Eighty-eight percent of U.S.
university counseling services directors reported a recent trend in the amount of students with
severe psychological problems on their campuses according to 2012 data from The National
Survey of College Counseling. Concurrently, the number of American students studying abroad
has also increased. Most recent annular data from the Institute of International Educational Open
Doors reported a 2.1 percent increase of students studying abroad for academic credit during the
2012/2013 academic year (2013). The number of students studying abroad with physical and
mental disabilities has also increased in recent years. From 2006/2007- 2012/2013 there has
been a 2.5 percent increase of students with disabilities participating in an education abroad
program for academic credit.
National data. The most recent data showed the total number of students with
disabilities studying abroad totaled 3,194. Students with disabilities accounted for 5.1 percent of

MENTAL HEALTH ABROAD PROPOSAL

total number of students in the U.S. who participated in a study abroad program in 2012/2013.
Of that, 27.9 percent of students reported having a mental disability (Institute of International
Education, 2014). With an increase in both students presenting mental health concerns and
students studying abroad, there is an apparent need for the development of a mental health predeparture resource for students with mental health considerations.
Age considerations. The average age of an individual presenting with a mental illness
has changed dramatically over the years. Fifty years ago, the onset of a mood disorder was the
age of 30. Recent data suggests that average age for a mood disorder to present is around the age
of 15 (Evans et al., 2005). A mood disorder may present early, but may go untreated, improperly
diagnosed, or undiagnosed by the time a student enters college. The average age of collegegoing individuals is between the ages of 18 and 24, which is a critical time period for mental
health diagnoses. Many students who have mental health concerns and are interested in study
abroad tend to disclose more frequently than those with other forms of disabilities. The Institute
of International Education/Mobility International USA along with the U.S. Department of
Education have reported students with mental disabilities studying abroad disclose twice as
frequently as those with other disabilities, 45 percent vs. 22 percent (2004).
Counseling services data. A recent study of students using campus counseling centers
reported, the rates of students presenting with problems of depression, anxiety, suicidal
ideation, and sexual assault have doubled, tripled, and in some instances, quadrupled over the
past 12 years (Benton, S., Robertson, J., Tseng, W., Newton, F. & Benton, S., 2003, p. 274).
Furthermore, a survey of campus directors of counseling services reported a 70 percent increase
in self-mutilation (deliberate self-injury such as cutting ones arm with a knife or burning
cigarettes into the skin) (Gallagher, 2004, p. 2). Also noted was the increase of female students

MENTAL HEALTH ABROAD PROPOSAL

presenting with eating disorders, with around 40 percent struggling with an eating disorder in
comparison to their male counterparts (Grayson & Meilman, 1999). Additionally, around 35
percent of students who seek out counseling services are or have been taking psychotropic
medication to cope with and treat their mental illness (Gallagher, 2003). Some counseling
services at larger institutions have even taken the initiative to arrange psychiatric hospitalization
for students on a routine basis to offer additional support for more serious forms of mental health
issues.
Emotional considerations. National studies suggest that college age students are
experiencing more emotional problems than previously recorded. A study done by the American
College Health Association revealed that almost fifty percent of students, both undergraduate
and graduate, reported having problems emotionally and mentally which hindered their ability to
function socially, professionally, and academically (American College Health Association,
2004). Moreover, around ten percent of students reported seriously contemplating suicide
(2004). The rate of college students attempting suicide is ten times higher than that of college
students committing suicide (Marano, 2004). With suicide being the second leading cause of
death among traditional college-age students (2004) and more students are presenting with
mental health programs, it is crucial that on-campus mental health support services are offered.
UW-Platteville services. In relation to study abroad, the UW-Platteville Education
Abroad Office collaborates with counseling services when a student discloses their mental health
concern. This is done by the use of the Medical and Self-Disclosure Forms (see Appendix A)
that all students are required to complete in the post-acceptance process. The earlier a student
discloses, the better their needs can be accommodated. As for pre-departure mental health
support, the only type of support that exists is referring the student to on-campus counseling

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services. Previously there has been a focus on ways to cope after a study abroad experience has
completed, which includes some information related to mental health concerns.
However, there is currently no concrete resource dedicated to pre-departure mental health
at UW-Platteville. This type of resource is needed to extend additional resources and support to
students studying abroad, as the number of students studying abroad in UW-Platteville sponsored
programs continue to increase. Six semester/academic year UW-Platteville sponsored programs
are currently offered to UW-Platteville students and 14 additional colleges throughout the nation.
Being university sponsored, the Education Abroad Office develops all pre-departure materials
and resources that are then available to UW-Platteville and non-UW-Platteville students studying
through the university sponsored programs.
Target audience. The main target audience for this project will be UW-Platteville and
non-Platteville students studying abroad on UW-Platteville Education Abroad programs. My
proposed additions and recommendations to the current pre-departure program will serve as a
resource to help students better mentally prepare for their study abroad experience prior to
departure. Additionally, this project will inform home and host institution education abroad staff
members and resident directors about potential mental health concerns students may encounter
while abroad. This pre-departure resource will be shared with students before departure, and be
made available to the on-site coordinators at each host institution, as previously mentioned. By
making the resource also available to those at the host institution, whose staff generally lack
formal training in counseling, they are finding themselves dealing with a larger depth and
breadth of students presenting with psychological distresses abroad (Lucas, 2009), and therefore,
will be able to better receive and support students with mental health related issues.

MENTAL HEALTH ABROAD PROPOSAL

Project significance. The number of college students participating in study abroad


programs has steadily increased over the past two decades, as reported by the Institute of
International Education (Fast Facts, 2012/13, 2013). The number of students going abroad is
expected to increase in the upcoming years. At the same time, the number of traditional-aged
college students presenting with mental health concerns have increased dramatically over the
years (American College Health Association, 2004). To no surprise, it is anticipated that the
number of students with mental health concerns will continue to increase. The significance of
this project is to develop a comprehensive mental health abroad program/resource to help
students and education abroad professionals, to become better aware of psychological issues that
may arise or become triggered while abroad. Currently, no concrete preparatory mental health
abroad resource exists at UW-Platteville. By implementing this project students, education
abroad professionals, staff, and faculty can learn ways to identify and support mental health
issues as they relate to the study abroad experience.
Project results. As a result of this project, student mental health disclosure will increase
and students will be better served and supported before and during their study abroad program.
Currently, students are required to complete a disability disclosure form post-acceptance, and
few students think to disclose mental health issues. This has been attributed to the fear of being
screened out (Legget, 2012) or being denied to study abroad on the grounds of not being
mentally stable to do so (McCabe, 2005). My hopes are to break the stigma surrounding mental
health issues and help students become more open about their psychological health in order to
better support and accommodate them both on and off-campus. Another result of this project
will be the increased use of the university counseling services. If there is an increase of students
disclosing mental health concerns we can then encourage and refer the students to counseling

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services. To our advantage, counseling services is housed in the same building as the Education
Abroad Office, making accessibility a favorable factor in referring students.
Project stakeholders. The project will involve various stakeholders, primarily at the
University of Wisconsin Platteville (UW-Platteville). Stakeholders will include UWPlatteville and Non-Platteville students, Education Abroad staff at UW-Platteville, Cooperative
Institutions (Co-ops), and host institutions, the Department of International Programs, the
University Counseling Services (UCS), Disability Services, outside mental health providers, and
communities within the Platteville area as well as communities outside of Platteville (such as
those found near cooperative institutions).
Students and staff. The mental health pre-departure resource will provide UWPlatteville and Non-Platteville students with education and information about mental health
concerns that may present or become triggered while abroad. UW-Platteville Education Abroad
programs are offered to all UW-System students as well as a few cooperative institution across
the nation. Additionally, the project will provide education abroad staff at UW-Platteville, Coops, and host institutions with information regarding mental health concerns that may be
unfamiliar to them. Most staff lack formal training in supporting mental health; therefore this
resource will serve as a way they can support their students, become educated, and properly refer
students to supportive mental health services both on and off-campus.
Department of international programs. Most importantly will be the support and
approval from the Department of International Programs (DIP) in order for the project to be
successfully implemented. The director will have to review all material before it is shared and
published. The DIP will benefit, as it will be able to better serve its students. This will also
increase risk-management as it relates to the education abroad programs, as more students will

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be disclosing disabilities. With an increase of disclosure, we can better support and


accommodate students before they arrive in their host country.
Institutional services. Probably one of the most important key stakeholders will be the
University Counseling Services (USC) at UW-Platteville. The mental health resource will have
to be reviewed and approved by the UCS before being distributed. UCS will be familiar with
FERPA, HIPPA, and ADA disability laws and be able to assess and assure its adherence to these
acts and laws. The USC will benefit, as more students will be using their services and students
will become more educated about mental health and the services available. Additionally,
Disability Services will need to work with the UCS to ensure the resource is in accordance with
disability laws and includes the necessary and transparent disability and disclosure information.
Disability Services is also expected to experience an increase in students using their services as
students will become more aware of study abroad program access to students with disabilities,
such as mental health, through the development of this program.
Outside providers and the community. The project will need the support of outside
mental health providers, as some services may not be available at the UCS. Additionally the
UCS may not be fully equipped to handle or adequately support students with psychological
concerns. Outside providers will benefit as students will be using their services and they will be
supporting students with mental health needs. Also, the Platteville community will benefit, as
students will become more aware of mental health services that are available. The overall health
and wellness of the Platteville community and surrounding communities will benefit, as students
will be thriving mentally. With the campus community becoming more educated about mental
health concerns they will be able to educate others around them in their home and host
communities.

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Purpose of the Project


The purpose of this project is to better prepare and adequately support students who are
participating in UW-Plattevilles Education Abroad programs through the development of a
supplementary mental health pre-departure orientation program and mental health abroad
manual. Previously developed mental health resources by the Department of International
Programs and University Counseling Services have focused on the mental health of students
returning after participating on a study abroad program. This project would take a more
preparatory approach, as it will build awareness of possible mental health related issues students
may encounter before, during, and after their experience abroad. Though this project will be
developed specifically for mental health student support, it will also serve as a guide and
reference for education abroad professionals, faculty, coordinators, and directors both at the
students home and host institution.
This project will also take a preventative approach, as it will describe some mental health
situations education abroad professionals can expect students to face while abroad. This will
better prepare education abroad professionals in advance for properly handling mental health
situations. Additionally, it will provide general information about mental health issues and offer
suggestions for ways education abroad professionals can support and refer students to adequate
resources at home and in country. Furthermore, most education abroad staff do not and are not
expected to have a formal background in counseling or psychology. However, by providing
them with the proposed resources, they and their students can become better aware of what to do
in mental health crisis situations.

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Assessment of the Project


The assessment of this project will include surveys and secondary data analyses.
Students, and education abroad staff, both at the students home and host institution, will
participate in surveys in order to successfully identify: (1) areas for improvement, (2) areas of
success, (3) existing gaps in the already established pre-departure orientation, (4) best methods
of delivery, and (5) future suggestions for the newly developed program. Secondary data
analyses from similar program implementations will also be used as a tool for comparison with
data collected from the new pre-departure program. All methods of assessment will help to
better establish future programs and learning outcomes of the proposed program.
Learning Outcomes
Two primary learning outcomes have been developed with the goals of the project in
mind. The learning outcomes include the following:

After completing the Mental Health Abroad pre-departure program students will
be able to identify, define, and solve problems relevant to the process of crosscultural adjustment as it relates to mental health before the departure of their
study abroad program as evidenced by completing of the pre-departure
assessment and returnee assessment.

After completing the Mental Health Abroad pre-departure program students will
feel more comfortable discussing and disclosing personal mental health concerns
as evidenced by their responses to the survey delivered after the mental health
abroad pre-departure orientation session.

After implementation of the Mental Health Abroad pre-departure program


education abroad personnel will report increased communication by students

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related to personal mental health issues as evidenced by an annual review of


cases.
All learning outcomes outlined in this proposal align with the institutional mission at UWPlatteville, and foster the mission, vision, and goals within the Department of International
Programs. Successful completion of the second learning outcome will also allow the Education
Abroad Office, Counseling Services, and Disability Services to better support students with
mental health concerns studying abroad in a more collaborative manner.
Methods of Assessment
Being able to properly assess the proposed program is imperative as the higher education,
study abroad, and mental health landscapes are ever changing. As these landscapes change, the
program must change as well in order to remain current, successful, and ultimately useful. The
following methods of assessment will be used to evaluate the new program:

Pre and post assessments of learning and knowledge gained before and after
participating in the pre-departure orientation program (see Appendix B). In
assessing new knowledge gained related to cross-cultural adjustment, students
will be given possible scenarios in a focus-group like setting. Students will first
write down how they would react to the scenario, then be asked to share their
response with the group.

Upon return from studying abroad students will be surveyed on their abroad
experiences as it relates to their mental health before, during, and after their
study-abroad experience as well as their comfort with discussing and/or revealing
any personal issues related to mental health. They will also be surveyed on

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aspects related to the quality, value, and usefulness of the new mental health predeparture program (see Appendix C).

Education abroad personnel will annually review cases related to mental health
before, during, and after a study-abroad experience, specifically noting
improvements in communication by students about mental health issues (see
Appendix D).

Additionally, Education abroad professionals at UW-Platteville, cooperative, and


sending institutions will complete surveys on mental health related services and
support available to students at their home institution and will be both open and
close-ended questions. This information will be collected and be made available
on the UW-Platteville Education abroad under Safety and Health Abroad
Website (see Appendix E).

Performance indicators. By developing a mental health pre-departure resource for


students, the UW-Platteville Education Abroad staff foresees an increase of:

Students planning to study abroad who have mental health concerns will increase
by 5 % over a one-year period as a result of attending the mental health abroad
pre-departure session.

Students willing to disclose their mental health disability or concerns after


attending the mental health abroad pre-departure session will increase by 15%.

Students will become more knowledgeable about mental health concerns and selfdisclosing as a result of receiving the mental health abroad manual, as measured
by the amount of students who have checked off the learning content material,
indicating they have read and understand the Mental Health Abroad manual.

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Increased use of counseling services. It is also expected that there will be an increase in
use of counseling services by students studying abroad (a goal of a seven percent increase). An
increase in student referrals to individual and group counseling sessions for students planning to
study abroad (a goal of fifteen percent increase) is also anticipated during the first year after
program implementation.
Breaking the stigma. A more long-ranging implication is the hope of breaking the
stigma surrounding mental health by promoting and building awareness through the PR
Committee of Diversity and Inclusion. In order to gage this long-term implication, the
International Programs Office, Health Services, and Disability Services will work to develop a
campus wide survey in the future.
Campus-wide feedback. I also propose that all UW-Platteville students, faculty, and staff
will be asked to participate in the campus mental health survey every two years. With reference
to study abroad, there will be a question asking if they (the students) have participated in a study
abroad program. If answered yes, the individual will be routed to questions specific to mental
health as it related to their study abroad experience. The number of responses related to mental
health abroad will be disseminated with the Department of International Programs, thus
strengthening the purpose of the development of the mental health abroad pre-departure
program.
Closing the gap. Ultimately, the resource developed from the proposed project will aim
to address and fill the mental health disclosure gap UW-Platteville and many other institutions
are facing. There is a great deviation between the numbers of reported students verses the
number of potential students verses the number of actual students who have psychological issues
(Lucas, 2009). If, through this project, we can increase the number of students studying abroad

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to use on-campus and off-campus services to support their mental health needs, it is promising
that the overall disclosure and support of students with mental health concerns will also increase.
Secondary data analysis. Research and data will be collected from institutions that have
developed and implemented similar pre-departure program/resources. Collected research and
data will be used to compare and contrast data collected from the newly developed mental health
pre-departure program. Secondary data analysis will aid in program success and on-going
improvement of the program and mental health abroad manual. The secondary data analysis will
be conducted every two years or as new data and information from peer reviewed journal articles
and higher education institutions are published and/or released.
Program Implementation
To achieve the objective of successfully implementing the mental health pre-departure
orientation program and resource I propose a steering committee will be formed. The UWPlatteville Education Abroad Outreach Specialist will head the committee, who will work with
project leads in OHRD and OUA to select members of the campus community to serve on the
steering committee. This steering committee will be a diverse group of individuals with a range
of experiences in supportive student services, international programs, disability services, and
campus and community health services. The committee will work together to establish and carry
out the following phases of program implementation: (1) planning and program approval, (2)
program development, (3) program implementation, and (4) program review. The proposed
timeline from concept to realization for the proposed program is estimated to span over the
course of 10 to 15 months. The approximate timeline for implementation can be found in
Appendix F.

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Phase One: Planning and Program Approval


The first phase of implementation will involve planning and program approval with a
maximum timeline of six months to complete. This program proposal will be presented to the
Director of International Programs for review. Once approved, the proposal will be presented to
the International Council Committee (ICC). The ICC will hold quorum where members will
vote on the new program. As soon as the program gets voted in favor for development, the
program proposal will be sent to the Undergraduate Council Committee as an "information only"
item. As a final step in the approval process, the UW-Platteville Vice Chancellor/Director of
Strategic Planning and Implementation will review the program proposal for budget and funding
approval. After receiving budget approval, the steering committee will assign preliminary
marketing and promotional duties to the education abroad interns assigned to the program
implementation. Interns will begin communication with interested stakeholders via e-mail in
order to develop campus and community interest, as well as potential buy-in. Interested staff,
faculty, and community members will be encouraged to join the already established steering
committee as they move into the program development phase.
Phase Two: Program Development
The second phase of implementation will be the program development and is expected to
take two to four months to complete. The steering committee will develop all aspects related to
designing, promoting, and full implementation of the new mental health pre-departure program
and manual. Modules to be covered in the pre-departure session and the manual will be:

An overview of mental health abroad

How to adjust to a new cultural experience away from home

Cross-cultural adjustment

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Culture Shock

Disclosing mental health concerns

Preparing for the education abroad experience

Tip for students traveling with mental health concerns

Identifying when a student is in crisis

Dealing with depression abroad

Ways to reduce stress abroad

Ways to ensure a good nights rest

Questions to ask UW-Platteville Education Abroad, counseling services, disability


services, and your health care physician

Mental health emergency care abroad

Mental health resources on campus, in the community, online, and abroad

In this phase, student and education abroad staff surveys will be created. Pre and post
surveys for students participating in a semester or longer programs will be created and later
added to the current pre-departure and returnee surveys. Another student survey will be created
related to the quality and usefulness of the face-to-face mental health pre-departure orientation
session. Lastly, a survey on on-campus mental health support and services (including both open
and close-ended questions) will be developed for education abroad staff, resident directors, and
on-site coordinators.
After the surveys are created, members of the steering committee will submit them to the
UW-Platteville Student Affairs Assessment Department to ensure they are compliant with CAS
Standards. Next, all written and visual components for the mental health abroad manual and the
pre-departure orientation will be created. After the surveys are approved, the Director of

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International Programs will review both the surveys and the draft of the manual. After review,
final edits will be done and resubmitted for final approval from the Director and Assistant
Director of International Programs.
Phase Three: Program Implementation
The third phase will be the implementation of the developed program. The program
implementation is expected to take one to two months to accomplish. In this phase, the predeparture and returnee student surveys will be attached to the next application cycles to open for
semester or longer programs. They will appear as application components in the students
applications, specifically in the application sections labeled post-decision and returnee. (To
be noted: all applications are entirely digital and are housed within StudioAbroad, an online
software that is Internet accessible.)
Mental health abroad manual. The manual will first be made available as a learning
material for students in the study abroad application portal. Learning materials are digital print
resources made for all students to read in order to better prepare them for a study abroad
experience, no matter the duration. Next, the manual will be added to the UW-Platteville
Education Abroad website. The resource will be listed under the area health and safety abroad
and accessible by clicking on the mental health abroad tab.
Observational survey. The observational survey for education abroad professionals will
be made accessible through the website SurveyMonkey. A link to the survey will be emailed
to sending institutions, cooperative institutions, on-site coordinators, and host institution resident
directors each year. Completed surveys will be emailed to the studyabroad@uwplatt.edu email.
Survey data will be collected as received by designated interns or ambassadors in the Education
Abroad Office.

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Marketing. The mental health pre-departure orientation session will be promoted via
email, campus newspaper, and social media sites. Marketing efforts will be geared towards
students planning to study abroad the following semester or longer. All marketing and
promoting will be carried out by the Education Abroad Marketing intern who will submit drafts
of marketing materials to the Education Abroad Outreach Specialist for approval. E-mail
marketing will be facilitated through MailChimp in a newsletter format and social media
marketing will be facilitated through HootSuite. Additionally, the Education Abroad
Communications Intern will submit drafts of the newspaper submissions to the Pioneer Press for
review and publication about the pre-departure session.
Pre-departure session. Members of the steering committee will be selected to deliver
the mental health pre-departure orientation in a face-to-face large group session. All students
participating on semester or longer programs for the following academic term will be required to
attend pre-departure orientation. Those on short-term programs, such as winterim and summer
sessions, will be encouraged to attend the mental health session but will not be required. Key
stakeholders will be invited to the session and all stakeholders and members involved will
receive a recorded version of the session.
Phase Four: Program Review
In the final phase of implementation, the program will be reviewed and assessed. The
review process of the newly created program is estimated to take one to three months to
accomplish however, on-going review may also occur as needed. The steering committee will
work to collect data from the student and education abroad staff surveys. Members from the
International Programs Office and the steering committee will analyze and interpret data. The
data will also be sent to the Ancillary Assessment Council (AAC) for further analysis. The AAC

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will send results back to the International Programs Office (IPO) and post the results on the AAC
web page on the UW-Platteville Assessment website. After, the IPO will deliver the results to
the ICC followed by an open forum. Minute notes will be taken detailing future directions and
suggestions for program/resource improvements and modifications. Future directions and
improvements will be presented at the annual IPO staff retreat. A result of the retreat will be the
development of an action plan. This action plan will initiate changes or modifications for the
mental health pre-departure orientation and edits to the mental health abroad manual.
Budget Narrative
Budget Analysis
The budget for the proposed Mental Health Abroad Pre-Departure Program will include
direct and indirect costs that will total approximately $16,000 over a span of two years (see
Appendix G). As with any new project implementation, there may be some unforeseeable costs
that will need to be addressed. Due to this, a contingency fund will also be included for the
anticipated expenses and addressed at a later date. The direct costs of the project will primarily
be comprised of staff, intern, consultants, production, and promotion costs. Indirect costs will
include the funding from outside sources for a graduate research assistant, study abroad grants
for students, training for on-site host country staff, and other sponsored activities.
Direct costs. The main facilitator of the project, the Education Abroad Outreach
Specialist, will receive a one-time annual stipend of $2,000 in exchange for 118 hours of work
during the first year. The stipend will be disbursed in two payments, half disbursed at the start of
the fiscal year and remainder disbursed at the middle of the fiscal year. Two additional staff
members, one from University Counseling Services, and the other from Disability services will
also receive a one-time stipend of $1,000 (equal to 60 hours of work) each in facilitating the

MENTAL HEALTH ABROAD PROPOSAL

23

development and successful implementation of the project in direct collaboration with the
Education Abroad Outreach Specialist during the first year. These stipends will follow the same
disbursement schedule mentioned above. An intern will also receive a one-time stipend of $150
for 23 hours of work assisting the project team over the course of a semester. All stipends will
be directly funded by the Department of International Programs cost recovery model.
Supplementary fringe benefits could be awarded and will be revisited upon program approval
and discussed with involved stakeholders.
Additionally, the budget will include consultation fees from the following organizations
that may also include the use of and distribution of their direct resources: NAFSA, SAFETI, and
Southwest Behavioral Health (a community mental health provider located in Platteville). The
UW-Platteville University Counseling Services (UCS) already has an established agreement and
contract with Southwest Behavioral Health and they would serve as our primary community
partnership. The UCS will fund some of the related consultation and resource costs, estimated to
be around $200-$400 over the course of two years.
Once the program has been fully developed and is ready for implementation at the predeparture orientation sessions (which occur twice each academic year) there will be necessary
materials, equipment and marketing materials that will be accounted for in the budget each year.
A space on campus will need to be reserved, along with a computer, and a projector. The budget
for these items total around $50 and an additional $75 will need to be budgeted to pay for the
setup crew each orientation session. The project will be made available on the Education Abroad
website, the StudioAbroad application portal, and an individual resource packet will need to be
printed for each student. Costs related to the website, portal, and printed materials is estimated
to be around $500. Promotional materials such as posters and brochures are not included in the

MENTAL HEALTH ABROAD PROPOSAL

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above costs, and are estimated at $240. All expenses again will be funded by the International
Programs cost recovery fund.
Indirect costs. Some indirect costs are expected, and will receive funding outside of the
Department of International Programs. When approved, the project is expected to utilize workstudy grants to fund a graduate research assistant from the School of Counseling at UWPlatteville. If approved, an eligible student would receive a $1,725 semester work-study grant,
equal to three graduate-student credits of tuition. This amount is equivalent to three graduate
student credits. Additionally, the budget will include indirect costs to fund on-site host
institution staff training. These costs are to be paid by cooperative institutions, with an estimated
cost of $150 per year. Other sponsored activities will also be included in the budget, such as but
not limited to: publishing, additional training, workshops, and data collection. Costs for other
sponsored activities will have a budget of $500 each year and be funded by fundraising activities
facilitated by the Global Exploration student organization.
Grants for students. Lastly, through the development of this project, a study abroad
grant will be developed for students needing mental health support abroad. A $500 grant will be
established for three eligible students who have disclosed mental health related issues needing
support and/or accommodations abroad. University Disability Services, University Counseling
Services, and the Division of Diversity and Inclusion at UW-Platteville will jointly fund these
grants. A contingency fund will also be worked into the budget, in the amount of $3,000, funded
by the Division of Strategic Planning and Implementation.
Summary
This detailed program proposal seeks approval from the Director of International
Programs and the University of Wisconsin Platteville. The proposed mental health pre-departure

MENTAL HEALTH ABROAD PROPOSAL

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program and mental health abroad resource will serve both UW-Platteville students and those
participating on UW-Platteville Education Abroad sponsored programs. It is our hope that
through this program we are able to increase the understanding of mental health concerns and
how they can affect the study abroad experience before, during, and after. Through this program
students will: (1) be mentally prepared for challenges related to studying abroad, (2) know what
resources are available, (3) know how and when to disclose their concerns and/or disability, and
(4) become better aware of mental health supportive services available at their home and host
institutions.
The above mentioned program and learning outcomes outlined in this proposal will
benefit both the institution and the students in a constructive way as they will contribute to
making UW-Platteville a better campus and the Platteville area a stronger community. With the
rise of students presenting with mental health issues it is our mission to support them in any way
possible. By approving this new program, we will accomplish our goals of increasing the rate of
self-disclosure, increasing the use of University Counseling services, and we will ultimately
contribute to making progress towards breaking the negative stigma associated with mental
health concerns.

MENTAL HEALTH ABROAD PROPOSAL


Appendix A
Mandatory Post-Program Acceptance Disability and Medical Disclosure Forms
Disability Disclosure Questionnaire
1. Do you have a hearing impairment?
2. Do you have a speech impairment?
3. Do you have a visual impairment?
4. Do you have a mobility impairment?
5. Do you have a chronic condition? (E.g. arthritis, asthma, diabetes, epilepsy, chemical dependency)
6. Do you have any known learning disability?
7. If you have a disability, please list any accommodations requested:
Medical Disclosure Questionnaire (Post Program Acceptance)
1. Do you have any dietary restrictions?
2. Do you currently receive any treatments or medication on a regular basis?
3. Will you be taking prescription medication abroad?
4. Do you have any allergies to medication, plants, food, animals, insect stings, etc.?
5. In the past year, have you had a major operation, or been advised to have one?
6. In the past year, have you had a major illness?
7. In the past year, have you been treated by a counselor, psychiatrist or psychologist?
8. If yes, do you anticipate being treated by a counselor, psychiatrist or psychologist while abroad?
9. Do you have any medical conditions or concerns that we should be aware of? (*)

26

MENTAL HEALTH ABROAD PROPOSAL

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Appendix B
Pre and Post Mental Health Pre-Departure Session Questionnaire
1. What do you/did you expect to gain from this session?

2. Do you or did you have any concerns before going abroad?

3. Are you/were you aware of cross-cultural adjustments? If so, how do you plan to adjust to
studying abroad in a different country, campus, culture?

Scenarios

You are feeling homesick a few weeks after arriving. What could you do you do to remedy this?
Who would you talk to about this?

You notice a fellow student is feeling sad, is withdrawn from the group, and often looks tired or
exhausted. What could you do to help? Who would you talk to about this?

Your roommate discloses to you they are taking medication for depression. After a few weeks
you notice they are happier than normal and at times extremely withdrawn. Explain how you can
help, and who could you contact:

You and a group of students go out during the day to an open outside social area. One of the
students hasnt disclosed they have social anxiety and experiences a panic attack. Can you think
of possible ways you could you help in this situation? Who would you contact?

MENTAL HEALTH ABROAD PROPOSAL

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Appendix C
Quality of Mental Health Pre-Departure Program and Manual Survey
What was the program and manual useful in relation to your study abroad experience? Y/N
If yes, how did you find it useful? If not, do you have any suggestions to make the program/manual
better or most useful?
On a scale of 1-5 (1 being poor and 5 being excellent) how would you rate the quality of the mental health
pre-departure program? Please submit your answer:
1

On a scale of 1-5 (1 being poor and 5 being excellent) how would you rate the value of the mental health
pre-departure program? Please circle your answer:
1

On a scale of 1-5 (1 being poor and 5 being excellent) how would you rate the quality of the mental health
manual? Please circle your answer:
1

On a scale of 1-5 (1 being not useful at all and 5 being extremely useful) how would you rate the
usefulness of the mental health manual? Please circle your answer:
1

On a scale of 1-5 (1 being difficult to find and 5 being very easy to find) how would you rate the visibility
of the mental health manual? Please circle your answer:
1

While abroad, did you ever refer to the mental health abroad manual? If yes, how frequently?
Do you have any additional suggestions as to how we can improve this mental health abroad predeparture program or manual for future students or unanswered questions at this time?

MENTAL HEALTH ABROAD PROPOSAL

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Appendix D
Annual Survey Related to Student Mental Health Study Abroad Experience
1. Was there an increase or decrease in student self-disclosure?
2. Was there an increase or decrease in the use of University Counseling services?
3. How many student referrals were made to on-campus counseling services? As in what % of
students were seen?
4. What were the results of the Pre and Post Mental Health Pre-Departure Session Questionnaire?
Please interpret and summarize results to the best of your ability:
5. What were the results of the Quality of Mental Health Pre-Departure Program and Manual
Survey? Please interpret and summarize results to the best of your ability:
6. Were any cases reported of student mental health concerns while abroad?
7. Were there any cases requiring a student to utilize in-country services or support?
8. Were there any cases requiring a student to be hospitalized for mental health related concerns
abroad?
9. How were concerns communicated to the UW-Platteville Education Abroad Office? From the
student? From on-site staff? From an external source?
10. What can we do moving forward to increase mental health support for our students before,
during, and after their abroad experience?

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Appendix E
Mental Health Services and Support Availability Survey
1. Does your institution have an on-campus health services?
2. Does your institution offer on-campus mental health services?
3. What percent of students currently use on-campus services?
4. Has there been an increase or decrease over the years of students using on-campus services?
5. What mental health concerns or issues are most prevalent in your student population?
6. Do they students have to pay to use on-campus services? Or is it included in their segregated
fees?
7. What are the hours and availability for your on-campus services available?
8. How can students contact these on-campus services?
9. In what ways does your institution support students to thrive mentally? (For example: selfdisclosure system, accommodations, events, groups, clubs, etc.)
10. Does the community have mental health services near your institution?
11. Does your institution have a mental health referral system?
12. Where can students go to find more information about mental health support and services?
13. Are students able to obtain prescription medication and/or refills through your on-campus health
services?
14. Are there any crisis hotlines your campus promotes for students to use if they find themselves in a
crisis situation? Where is this information visible?

MENTAL HEALTH ABROAD PROPOSAL


Appendix F
Suggested Implementation Timeline: Mental Health Abroad Pre-Departure Program
Person(s) Responsible
EAOS, OHRD, and
OUA
Steering Committee,
IPO Director, ICC,
UCC, VC/SPI
Director

Timeline
Pre-Program
Approval
Phase I
0-6 Months

Steering Committee,
EA interns, EA
ambassadors

Phase II
2-4 Months

Steering Committee,
EA interns, EA
Ambassadors

Phase III
1-2 Months

IPO, ACC, ICC

Phase IV
1-3 Months
On-going

Activity
Create steering committee to develop program
Planning and Program Approval
-Review of proposal by IPO Director
-Proposal presented to ICC
ICC quorum
-Proposal sent to UCC
-Review and approval by VC/SPI Director
Budget and funding model approval
-Gain of stakeholder interest and buy-in
Program Development
-Module Content development for:
Group session
Mental Health Abroad Manual
-Program design and promotion
Face-to-face
Online
Print
-Survey creation
Pre and Post
Quality of program
On-campus mental health services and support
-Submit surveys to SAA Department for CAS standard approval
-Review of surveys and content by IPO Director
-Submit final content and surveys for approval by IPO Director
Program Implementation
-Attach pre and post surveys to study abroad applications
-Add manual to learning content section of application
-Add manual to UW-Platteville Education Abroad website
-Upload on-campus survey to SurveyMonkey
-Marketing and promotion
Print and digital
-Delivery program to students on upcoming programs
-Invite stakeholders to attend the session
-Record session
Program Review
-Data Collection by IPO
-Analysis and interpretation of data by ACC
-Results delivered to ICC
-Future directions and improvements presented at IPO staff retreat
-Development of action plan for program improvements by IPO staff

31

MENTAL HEALTH ABROAD PROPOSAL

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Appendix G
Two-Year Projected Budget
Direct Costs

YR1

YR2

Staff Stipend
EA Outreach Specialist Stipend
Counseling Services Staff Stipend
Disability Services Staff Stipend

$2,000
$1,000
$1,000

$1,000
$500
$500

$150
$75

Volunteer basis
$75

$500
$150
$50
$50

$250
$150
$50
$50

$20
$25
$35

$20
$25
$35

$450

$450

$50
$125
$35

$50
$125
$35

YR1

YR2

$1,725
$150
$30

$1,725
$50
$30

$100
$200
$100
$500
$1,500

$100
$200
$100
$500
$1,000

Intern Stipend
EA Interns
Setup Crew
Consultant Costs
Community Mental Health Providers
NAFSA Forum Community Membership
SAFETI Forum Community Membership
Norte Dame Collaborative Use Permission
Equipment
Projector Rental
Space Reservation
StudioAbroad Maintenance
Materials
Printed Pre-Departure Packets
Marketing
Design Services
Publications (Posters, Brochures)
Website Updates

Indirect Costs
School of Counseling GA Research
3 Credit Work-Study Grant Agreement
Host Institution EA Staff Training
Text Referral System
Other Sponsored Activities
Publishing
Additional Training
Data Collection (on surveys)
Health Services Abroad Grant
Assessment
Total:
2YR Projected Total:

$10,030

$6,530
$16,560

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Appendix H
Literature Review
Mental Health Abroad: A Literature Review
For many years college students across the nation have participated in study abroad
programs all over the world. In most recent years, it has been noted that there has been an
increase in students studying abroad that have mental health concerns. In fact, the numbers of
both students studying abroad and students with psychological issues have increased in the most
recent years, as noted by the Institute of International Education (2013). Many benefits can be
defined and directly related to the study abroad experience. However, a dark side exists. This
literature review will examine the current landscape of both student abroad and mental health as
they relate to U.S. college students. It will identify benefits and challenges as they relate to the
study abroad experience. Additionally, it will provide information pertinent to preparation,
assessment, support, and suggestions for future direction.
A Brief History of Study Abroad
Students from the U.S. have been studying abroad for nearly 100 years. This first official
study abroad program to receive academic credit was launched in 1923 at the University of
Delaware (Our History, 2013). Professor Raymond W. Kirkbride developed the study abroad
program, set in France, geared towards students in their junior year. During this time, studying
abroad was unheard of in the U.S. and few Americans were traveling abroad. This was due to
the isolationist tendencies American still held, as World War I had recently ended (2013, p. 1).
Despite this, the President of the University of Delaware recognized the many benefits of
studying as students become better-rounded, learned foreign languages, gained a global

MENTAL HEALTH ABROAD PROPOSAL

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perspective, adapted cross-cultural understanding, and provided an opportunity for students to


pursue international career paths (2013).
The first group of students set sail to France in July of 1923 and then participated in a sixweek intensive French language program at the University of Nancy. After, they settled in Paris
for the remainder of the program. Programs where two students won the highly coveted
diploma of French civilization (2013, p. 1). The program was deemed a success and the
University of Delaware (UD) expanded their study abroad program to Switzerland and also
Germany. UD also hosted students from other colleges such as Columbia, Penn, Wellesley,
Brown, Harvard, and Princeton. Their now established, Junior Year Abroad program was a
success, and between the years of 1923 and 1948 a total of 902 students studied abroad through
UD during their junior year (2013).
Study abroad programs were halted due the World War II, but resumed in 1972. A new
winterim (j-term) program was being established and now students had the opportunity to study
in places such as London, Paris, Rome, Vienna, Munich, Berlin, and Hamburg. Later a program
in Geneva was developed, and has been the most popular study abroad program offered through
UD. Today, over forty percent of UD students take advantage of study abroad opportunities
through the university and UD often ranks in the top ten as a national leader of study abroad
programs. Currently UD offers over 60 programs and have added some exotic opportunities to
study in New Zealand, China, Tanzania, and Peru (2013).
Study Abroad Landscape
The number of college students participating on study abroad programs has steadily
increased over the years. According to the Institute of International Education (Fast Facts,
2012/13, 2013) the number of students studying abroad from 1987 to 2013 has grown from

MENTAL HEALTH ABROAD PROPOSAL

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62,000 students to 289,000 students. The number of U.S. students studying abroad has reached a
record high during the 2012/2013 academic year, with a two percent increase in participation
(2013). This increase of students studying abroad may be attributed to the many positive
benefits the experience has to offer outlined in the 2005 Commission on the Abraham Lincoln
Study Abroad Fellowship Program Study. Study abroad programs can foster personal and
academic growth as well as an increased proficiency in a foreign language (Limburg-Weber,
2009). Another benefit study abroad programs offer students, as described in the Journal of
Applied Cognitive Psychology, are cognitive benefits such as creativity (Lee, Therriault &
Linderholm, 2012).
Academic and personal benefits. IES Abroad, a study abroad program provider with
over 50 years of experience in the field, conducted an alumni student survey in the summer of
2002 that identified some core benefits of participating in a study abroad program. The survey
involved 3,400 alumni students from programs all over the world and ranging from 1950 to
1999. Respondents answered questions related to their academic, personal, intercultural, and
professional growth as a direct result of their study abroad experience. Academically, students
were often inspired to reach greater degree attainment, as more than 52 percent of respondents
indicated that they had achieved a post-graduate degree (McMillan & Opem, 2004, p. 58).
Furthermore, more than 80% of students reported their study abroad experience influenced their
interest in academic study and more than half reported their decision to, expand or change
their academic majors as a direct result of their experience (2004, p. 58). Students who studied
abroad in order to improve command of a foreign language indicated the immersion experience
their study abroad program provided that impacted their overall proficiency and use of another
language besides English. Additionally, 35% of respondents reported that they still use their

MENTAL HEALTH ABROAD PROPOSAL

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chosen foreign language of study in various aspects of day-to-day life (2004). Personally,
students reported having a better understanding of their own culture, values, beliefs, and
perceptions. The majority of students also stated feeling more mature and coming away with a
better understanding of themselves. Students surveyed also indicated having a more diverse
group of friends and almost all noticed an increase in self-confidence (2004).
Cognitive benefits. Apart from the IES study, another study on cognitive benefits of
studying abroad was conducted on students planning to study abroad; participants included 135
students who have and have not previously participated on a study abroad program from the
University of Florida and Georgia Southern University. The study showed a positive correlation
between cross-cultural experiences and creativity (Lee, Therriault, & Linderhom, 2012). The
study revealed some common themes, in that students, recruited and combined intellectual
resources from various cultural frameworks to generate ideas and solutions that were richer in
description, detail, and humor compared with students who had not studied abroad (p. 775). On
the domain-free creativity test of cultural creativity tasks, created by Lee, Therriault and
Linderholm in 2011 and adapted from the Abbreviated Torrance Test for Adults (ATTA),
students who studied abroad outperformed those who did not plan to study abroad. The test
involved three culture specific activities that involved both verbal and audible aspects. This
suggested that, cultural experiences lead to positive gains in cognitive processes associated with
general creative thinking as well (p. 775). Current research on creativity suggests that creative
thinking, in general, involves decision-making process that have a strong correlation to an
individuals level of intelligence (Kaufman et al., 2011; Nusbaum & Silvia, 2011). Therefore, it
is likely that students who participated in a study abroad may possess advanced creative,
strategic, introspective, and processing skills.

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Cross-cultural understanding. Both studying abroad and cross-cultural understanding


can often be found as undergraduate degree requirements at most universities, an increasing
number of institutions of higher education make commitments to internationalization (American
Council on Education, 2012). Higher education institutions often offer students an opportunity
to increase their cross-cultural understanding through or by completing a study abroad program
(Canfield, Low, & Hovestadt, 2009). Research related to cross-cultural understanding benefits
conducted by the University of Minnesota on Maximizing Study Abroad focused on study abroad
participants, program staff, coordinators, and professors of foreign languages (Cohen, Paige,
Shively, Emert, & Hoff, 2005). The study sampled 86 undergraduate students who studied
abroad for one semester in either a French or Spanish-speaking country. The sample of students
also had previous foreign language experience, most with at least three semesters of prior study,
with the target language in the country of study. The groups of students surveyed were a part of
the Spring 2003 and the following Fall 2003 cohort (2005). The research revealed the benefits
students directly receive from intercultural experiences, such as studying abroad. Cohen, et al.
(2008) and Vande Berg, Paige, & Lou (2012) suggested that institutions of higher education
should incorporate cross-cultural adjustment beliefs and expectations into their pre-departure
study abroad programming in addition to already effective material covered related to
intercultural aspects.
Mental Health Landscape
Concurrently, the number of college students with mental health concerns has also
increased over the years. A 2005 study done by the American Psychiatric Association found
that, nearly half of all college students report feeling so depressed that they have trouble
functioning, and 15 percent meet the criteria for depression (McCabe, 2005, p. 52).

MENTAL HEALTH ABROAD PROPOSAL

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Unsurprisingly, the number of students taking medication to manage mental illnesses has also
increased. The study found a 15.5 percent increase from 1994 to 2004 in students taking
psychiatric medications (2005). A different study conducted by the American College Health
Association (2004) revealed that around 45 percent of respondents, comprised of both graduate
and undergraduate students, stated having emotional issues that were detrimental to their
personal, academic, and professional well-being over the course of the past year. Additionally,
of the students surveyed, approximately ten percent contemplated suicide (American College
Health Association, 2004). The second leading cause of death among college students age 18-24
is suicide as reported in The Mental Health Crisis on Campus in Leadership Exchange.
Furthermore, the rate of college students attempting suicide is ten times the rate of completed
suicides among college students (Marano, 2004).
Age concerns. Due to the age of onset often presenting early in the developmental
process, more often than not, mental illness goes untreated, is improperly diagnosed, or
undiagnosed by the time a student enters college (Evans et al., 2005). Historically, the average
age of college-going individuals has been between the ages of 18 and 24 (Back to School
Statistics, 2014), thus being a critical time period for mental health diagnoses. Enrollment of
students between the ages of 18 to 24 has increased over the years. Between 2000 and 2012,
the 18- to 24-year-old population rose from approximately 27.3 million to approximately 31.4
million. The percentage of 18- to 24 year olds enrolled in college also was higher in 2012 (41
percent) than in 2000 (35.5 percent) (2014, p. 1).
Also, an overall increase in female college students was anticipated last year. About 12
million female students were estimated to attend in fall 2014, in comparison to with 9 million of
their male counterparts (Back to School Statistics, 2014). With an increase in female

MENTAL HEALTH ABROAD PROPOSAL

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enrollment, additional mental health services and support will be needed as the National Alliance
on Mental Illness (NAMI) reported, Women experience twice the rate of depression as men,
regardless of race or ethnic background. An estimated one in eight women will struggle with a
major depression in their lifetimes (Women and Depression, NAMI, 2009, p. 1).
Stressors. Related to studying abroad, students may encounter psychological challenges
and stressors they had not initially anticipated. Studies have shown that students may encounter
challenges related to distress, loneliness (Hunley, 2010), homesickness, stress, depression
(Brown & Holloway, 2008), home and host country disconnection (Pedersen, 2010), and
isolation, eating disorders, and relationship issues (Pavlova, Uher, & Papezova, 2008).
According to Lucas (2009), students may not be mentally prepared for these challenges
associated with cross-cultural adjustment. For some, mental health concerns could become
magnified while studying abroad and for others, new mental health issues could be triggered due
to unfamiliar stressors associated with the experience. On top of managing medications, social
pressures, anxiety, and adjusting to a new culture, students studying abroad may experience
issues with depersonalization or derealization. Depersonalization or derealization is the feeling
that one is not quite right in the world. Often the person experiences life as if he or she were a
robot, or an actor in a play (p. 200). All of these stressors can contribute to a students mental
distress, which can be both difficult to identify and adequately support.
Negative coping mechanisms. With adjusting to their new life abroad compounded by
psychological challenges, several studies have shown students turning to alcohol use and abuse
as a coping mechanism (Pedersen, LaBrie, Hummer, Larimer, & Lee, 2010). A 2011 study
conducted by the Society of Prevention Research, which involved 216 study abroad participants
from various educational institutions in the northwestern U.S., suggested that the consumption of

MENTAL HEALTH ABROAD PROPOSAL

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alcohol as a method of coping can be explained through the Social Norms Theory. Students are,
influenced to engage in behaviors based on perceptions of how others are behaving or how
accepting others are of their behavior (Pedersen et al., 2011, p. 402). The study also suggests
that if a student is studying abroad within a country with a popular drinking culture, the
likelihood of the student to engage in alcohol consumption increases. Other attributing factors to
alcohol use abroad are the believed perceptions students hold related to drinking behavior, of
those previous study abroad participants they know of or have had contact with. Students may
also hold perceptions of their own countrys drinking culture, which may lead to an increase in
alcohol-risk related behavior (2011). Pedersen et al. suggest ways to decrease alcohol
consumption risk by providing students with pre-departure education focused on cultural
competencies. In doing so, students will become more aware of cultural norms and standards
before going abroad. This may increase the probability of students acting in a more culturally
appropriate manner while reducing risky alcohol related predispositions (2011).
Preparation Concerns
With more students studying abroad, coupled with institutions of higher education
incorporating study abroad as a degree requirement, it will become increasing important to
prepare all students for the study abroad experience, especially those with mental health
concerns. The 2010 National Survey of Counseling Center Directors reported that, 10.8% of
university students surveyed sought counseling services each year (Gallagher, 2012). It is also
likely that there are many more students with mental health issues who do not seek counseling or
any other form of psychological care on or off campus (Marano, 2004). According to Gallagher,
this has caused a lot of pressure for both home and host institutions, as well as outside study

MENTAL HEALTH ABROAD PROPOSAL

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abroad program providers to identify, assist, and offer an increase in support to students with
mental health concerns (2012).
Institutional support. Lucas (2009) contended that students may be under the
misconception, that because they receive mental health support at their home institution that this
is a guaranteed service provided by their host institution abroad. Although mental health
concerns are not often seen as debilitating, limiting, or in need of accommodations, they are in
fact covered under disability law. However, there exists much debate surrounding the agency
and application of federal disability laws to study abroad programs (Kanter, 2003). Important
laws that detail regulation of disability discrimination in the context of higher education are
Section 504 of the Rehabilitation Act and ADA Titles II and III. Section 504, prohibits
discrimination against individuals with disabilities in connection with programs and activities
that receive financial assistance (National Council on Disability, 2012). ADA Title II states, in
the application of public institutions of higher education, that,
No qualified individual with a disability shall, by reason of such disability, be excluded
from participation in or be denied the benefits of the services, programs, or activities of a
public entity, or be subjected to discrimination by any such entity. (National Council on
Disability, 2012)
ADA Title III addresses disability law application with regards to private providers of public
accommodations in that,
Reasonable modifications be made to ensure that people with disabilities can fully and
equally enjoy public accommodations. Any entity that leases, owns, or operates a
public accommodation must make reasonable modifications to its premises that are

MENTAL HEALTH ABROAD PROPOSAL

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necessary for people with disabilities to access goods, services, facilities, privileges,
advantages, or accommodations. (National Council on Disability, 2013)
Yet to be clarified is the application of the above disability laws along with recent ADA
Amendments to programs offered by institutions that take place outside of the U.S. (such as
study abroad programs).
The University of Wisconsin-Platteville (UW-Platteville) is unique, in that it is an
institution and direct education abroad program provider. Of the six programs offered to both
UW-Platteville and non-Platteville students, two are direct extension of the campus. For UWPlatteville students, it could be assumed that if they receive mental health accommodations and
services at their home institution that this support would be available to them at the host
institutions, which are direct extensions of the university, as supported by current disability laws.
However, many host institutions are neither equipped to provide this support nor has the staff
been prepared to support these challenges (Lucas, 2009). Many resident directors of study
abroad programs, lack formal training and have expressed their concerns with being
underprepared to handle the breadth and depth of mental health issues students are dealing with
(Lucas, 2009, p. 187).
Host-country support. Additionally, some countries may not be capable of providing
mental health support. Extraterritorial (meaning, in this case, taking place outside of the U.S.)
application of federal laws have recently come into question as there is no mention in Section
504 nor Titles II or III of ADA concerning Americans studying abroad or American institutions
of higher education sponsored study abroad programs (Kanter, 2003, p. 305). Colleges and
universities should not assume these laws simply do not apply to study abroad programs due to
lack of clarification in current disability discrimination laws and should act as if they do apply

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(Sygall, 2006). Few courts have actually examined extraterritorial reach. In cases where the
federal courts have gone in favor of extraterritorial application for U.S. education abroad
programs, it cannot be expected that the international laws of another country will follow or align
with the enacted laws. Lindeman (2006) added that when an American university offers and
operates a study abroad program internationally (such as the case at UW-Platteville), and they
have students with disabilities receiving accommodations at their home institution, the institution
is expected to extend those reasonable accommodations abroad.
A growing support of international disability laws have surged since the U.S. enacted the
ADA. A total of almost 40 countries have passed similar laws banning disability-based
discrimination. In 2002, the United Nations enacted a Convention on the Rights of People with
Disabilities, which provides support in enforcing, domestic disability discrimination laws
throughout the world (Kanter, 2003, p. 318). In providing equal opportunity to all, U.S. study
abroad programs can set the example in other countries. Giving equal opportunity to those who
are disabled is the core mission of the Rehabilitation Act and the ADA. It would be in the best
interest of the United States Congress to extend extraterritorial application to study abroad
programs as it, expands opportunities for individuals with disabilities, as expressed by the
enactment of the ADA (p. 318).
Disclosure. Students are encouraged to disclose their mental health concerns early on to
their study abroad advisors, as Legget (2012) contended, in order to better identify programs that
can specifically support them. With both an increase in students studying abroad and student
presenting with mental health issues, it is expected that more students with mental health
concerns will participate in study abroad programs in the future. Promising is that fact that many
students who have mental health concerns and are interested in studying abroad tend to disclose

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more frequently than those with other forms of disabilities. The Institute of International
Education (IIE), Mobility International USA (MIUSA) along with the U.S. Department of
Education have reported that students with mental health issues studying abroad disclose twice
as frequently as those with other disabilities, 45 percent vs. 22 percent (American College of
Health Association, 2004).
No law currently exists requiring students to disclose their disability or states when they
ought to disclose during the study abroad advisement process. Therefore, it becomes
increasingly important to encourage students to disclose their physical, mental, or physiological
disability to their education abroad advisor early in the advisement process (Hoffa & Martin,
2005). Thankfully, organizations such as Mobility International USA have worked diligently to
identify programs that offer such services and international resources for students with mental
health issues. Legget (2012) stated, The goal is to identify ways to include and support
students, not screen them out (p. 11).
A primary resource an education abroad office may use is their institutions admissions
disclosure guidelines. Using the disclosure guidelines set by the institution helps reduce
discrimination and screening-out students with disabilities from participating in study abroad
programs (Hoffa & Martin, 2005). In general, institutions of postsecondary education are not
permitted to make what is known as a preadmission inquiry about an applicants disability
status (34 C.F.R. 104.42(b)-(c).). Although explicit preadmission inquiries are not acceptable,
study abroad advisors and counseling services can encourage applicants to self-disclose to better
accommodate them if accepted on a study abroad program.
Once the disability is disclosed, the student and the education abroad office can then
make a joint effort with disability services, on and off-campus healthcare providers, and the host

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institution abroad in appropriately determining the students full ability to participate while being
adequately supported (Leggett, 2012; Lucas, 2009). Specifically regarding mental health, it is
suggested that study abroad offices work cooperatively with both on-campus counseling services
and community health care services to develop pre-departure orientation that specifically focuses
on mental health concerns (Hulstrand, 2009). With collaborative efforts, institutions of higher
education are, better able to consider programmatic changes that lead to and sustain good
mental health (McCabe, 2005, p. 53).
Theoretical Foundations for Consideration
Social learning theory. One theory that could explain how students studying abroad can
be impacted mentally related to personality, social adjustment, and academic performance is the
Social Learning Theory. Social Learning Theory states two general factors related to human
behavior, one factor being expectancy and the other being the value of reward. In expectancy, an
individual acts in a certain manner in which he or she will receive reward for their behavior. In
receiving the reward for the behavior, the individual then assess how much they value the reward
(McLeod & Wainwright, 2009). The expectancy factor deals with what is called the locus of
control, this refers to how individuals make a connection to what is happening to them and
around them (Wilson & Taylor, 2013). Wilson and Taylor applied this theory (specifically the
concept of locus of control) by conducting focus groups of two separate sets of U.S. college
students. From the study, four major themes where identified after the completion of the study
abroad programs: (a) students endured stressful situations thought to be out of their central locus
of control, (b) students felt more self-confident, (c) students experienced positive personal
growth, (d) and students global perspectives changed (2013). Even though the students reported

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feeling pushed outside of their comfort zones, most felt they came away with a positive learning
experience (2013).
Culture shock lay theories. These theories could also provide an insight into mental
health concerns of students studying abroad. Culture shock, as defined by in Dr. Angulos
doctoral dissertation on Identity Change in Students Who Study Abroad, is, the realization that
expected behaviors and perceived vales of the new environment are disturbingly dissimilar from
home (2008, p. 6). Lay Theories are defined as, informal, common-sense explanations that
individuals provide for particular social behaviors or phenomena and that often differ markedly
from academic (i.e., expert) theories of the same phenomena (Furnham, Daoud, & Swami,
2009, p. 464).
A recent study conducted by the University of Redlands surveyed 149 U.S. students on
lay theories of culture shock. The findings of the study concluded that the students lay theories
of culture shock were attributed to internal and external factors. Internal factors identified by the
students were poor stress management, identity confusion, and prejudice. External factors
identified by the students were differences in languages, communication, and surroundings
(Goldstein & Keller, 2015, p. 192). Identifying both external and internal factors, which
comprised of psychological and socio-cultural components reaffirms Searle and Wards 1990
study on differentiating psychological well-being and socio-cultural competencies (p. 449).
Ultimately, the study suggests students were concerned more with how they adapted in a sociocultural sense rather than in a psychological sense as their source of culture shock (Goldstein &
Keller, 2015, p. 192).
Self-verification theory. Another theory that could inform the mental distress students
may endure while studying abroad is the Self-Verification Theory (Swann, 1997, 1983; Swann,

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47

Chang-Schneider, & Angulo, 2007). This theory, assumes that people actively work to preserve
their [own] self-views, even if these self-views are negative (North & Swann, 2009, p. 131).
Essentially, self-verification proposes that individuals form their purpose in life, how they
making meaning of the world around them, and their stability in life based on their own identities
(Swann et al., 2007). There are both benefits and disadvantages to self-verification. Direct
benefits include, psychological coherence, reduced anxiety, and improved health (p. 131).
Indirect benefits experienced can be, greater intimacy and trust in relationships and more
harmonious social interactions (p. 131).
Disadvantages of self-verifications are negative self-perception that leads to less selfconfidence, low- self-esteem, depression, and prolonged toxic relationships (North & Swann,
2009, p. 136). Those with similar self-views, tend to gravitate towards each other (2009). This
may become particularly challenging for students studying abroad, and being in a foreign
country with a likely dissimilar social environment to which the student is accustomed. Swann
and North recommend that students use a combination of cognitive and behavioral skills in order
to meet their self-verification needs (2009). However, those who share negative self-verification
may seek to build relationships with others holding similar negative views. This can become
detrimental to both students mental health, stability, and overall experience abroad. Thus, the
self-verification theory may provide insight as to how education abroad professionals and
students could enhance their own understanding of potential psychological and emotional issues
related to the study abroad experience.
Future Directions for Study Abroad
Education abroad professionals should devise an action plan, which involves mental
health pre-departure materials and resources (DeRomaa, 2011; Hulstrand, 2009). The action

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48

plan should include ways to promote self-disclosure without screening students out (Leggett,
2012), training for students on recognizing warning signs (Lucas, 2009), and training for staff on
how to support students with mental health concerns (Lindeman, 2006; Lucas 2009). Institutions
are encouraged to work with counseling staff on and off-campus health services to create and
implement successful trainings surrounding college student mental health concerns abroad.
Additionally, education abroad professionals should work to assess the accessibility of the
programs offered and develop advisement strategies for working with students with mental
health concerns.
Resources. A few resources exist that have truly helped in addressing mental health
concerns as they relate to study abroad. NAFSA (the International Educators Association) a
professional organization and front running international education, has two comprehensive
resources available: Best Practices in Addressing Mental Health Issues for Study Abroad
Participants (Lindeman, 2006) and Crisis Management in a Cross-Cultural Setting (Burak &
Hoffa, 2001). Both give detailed overviews on how education abroad professionals can assist
students with psychological challenges and cross-cultural adjustment. Lindeman outlines a
thorough pre-departure plan for education abroad professionals which recommends:
collaboration between counseling offices, preparing staff, advising students, and developing and
implementing mental health risk management procedures (2006).
Another great resource has been developed by the University of Notre Dames University
Counseling Center on the topic, Mental Health and Crisis Management: Assisting University of
Notre Dame Study Abroad Students (Settle et al., 2002-2011). Areas covered in the Notre Dame
guide are: mental health issues and disorders, international educator challenges and dilemmas,
and a list of available Internet resources for International educators (Settle et al., 2002-2011). In

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addition, many education abroad professionals frequently refer to the SAFETI (Safety Abroad
First Education Travel Information) Clearinghouse Project for resources on health and safety
issues. SAFETI provides information about mental health, crisis management, mental health
policy suggestions for policy administrators, and a resource that helps link students to English
speaking medical professionals abroad (Settle et al., 2002-2011).
Accessibility assessment. Lucas (2009) argued that education abroad professionals
should assess the accessibility of their current study abroad programs to better recognize
potential changes or potential opportunities to enhance program design for students with mental
health concerns. Once new possibilities are identified on study abroad program accessibility for
students with mental health needs, this information should be included and made available in the
institutions education abroad and counseling services resources. This creates awareness for
students pertinent to program possibilities and limitations while decreasing accessibility
assumptions due to lack of knowledge (Soneson & Cordano, 2009).
Areas of study abroad accessibility assessment can include the physical, academic,
cultural, informational, and policy/programmatic environments. The physical environment may
include: the residential facility, classrooms, program office, public spaces, and excursions. An
academic environment may include: teaching materials, teaching style, discussion format, and
information dissemination. The cultural environment may include: excursions, physical spaces,
interactions, organizations, and information notification. The informational environment could
include: program materials, resources, support services, and forms of communication. The
policy/programmatic environment may include: inclusivity statements, visual statements,
staffing, support services, points of contact, different formats of program and promotional
materials, forms, waivers, and program evaluations (Soneson & Cordano, 2009). More

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50

information on these environments and their context can be found in Universal Design and Study
Abroad: (Re_) Designing Programs for Effectiveness and Access. By assessing different
environments in the context of study abroad, education abroad offices can use this information to
become more responsive to the needs of students with mental health needs.
Advisement strategies. Study abroad advisement strategies for students with mental
health concerns are best executed when there is a supportive effort between the education abroad
office and their counseling services office. Printed and web-based study abroad resources with a
list of programs, specific to mental health supportive environments, should be made available in
both offices. Once a student communicates their interest, it is imperative to start the advisement
process early (it is suggested to start two months before general program application deadlines)
in order to identify possible programs (Hoffa & Martin, 2005). Of great importance to the
advising process is early disclosure before a student selects a program (2005). Advisors should
encourage students to self-disclose any concerns related to mental health as early as possible in
order to better accommodate them. Before acceptance, research mental health support services
or offices that are available in possible countries of interest. A helpful website to facilitate the
search (as previous mentioned) is the MIUSA site. Another strategy to better advise students
with mental health concerns interested in going abroad is to connect them with previous students
who have studied abroad (Soneson & Fisher, 2011). Once a student is accepted to a study
abroad program, ongoing communication is essential with the student, counseling services, the
host institution, and counseling services in the host country in fully preparing the student for
their study abroad experience.

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Conclusion
The number of students participating in study abroad programs continues to steadily
increase and numbers are expected to grow in the upcoming years (Institute of International
Education, 2013) as institutions of higher education make stronger commitments and dedication
to internationalization (American Council on Education, 2012). As participation in study abroad
programs continues to grow, students presenting with psychological concerns has also increased
at an alarming rate (American College Health Association, 2004). Building awareness around
student mental health concerns that could potentially arise while abroad is a must for study
abroad professionals and resident program directors (Lucas, 2009). Education abroad offices
should work collaboratively with counseling services on and off-campus along with disability
services to develop pre-departure materials and study abroad resources for students needing
mental health support. Once developed, these materials and resources will encourage more
students to disclose mental health concerns early and increase the use of counseling services.

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