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Notice Engage Refer Guideline

Signs of Distress

The terms “difficulty” or “distress” describe emotions or feelings that interfere with a person’s ability to carry out day-to-day activities.

Academic/Work Indicators

  • Noticeable changes in quality of work, attendance, productivity or participation (skipping class, absent from work).
  • Noticeable inconsistency and/or change in performance, responses to feedback, interactions with others.

Emotional and Behavioural Indicators

  • Changes in emotional responses (angry or hostile outbursts, tearfulness) from individual’s previous way of responding. 
  • Expressions of hopelessness, worthlessness, severe anxiety. 
  • Expression of suicidality and despair. 
  • Changes in behaviour from individual’s previous norm (e.g. overly withdrawn or extroverted, too little or too much sleep).

Physical Indicators

  • Noticeable changes in personal hygiene.
  • Frequent or chronic illness or absenteeism.
  • Disorganized, rapid or slurred speech.
  • Visible changes in weight, either loss or gain

Support Is…

Noticing when someone is struggling and having the confidence and courage to engage them.

Actively Listen

  • Empathy is the capacity to understand or feel what another human being is experiencing from within their frame of reference (Bellet & Maloney, 1991). 
  • Empathy is made up of two parts: (1) your intent and (2) the actual skill itself, i.e. reflecting feelings and words. 
  • It is a skill we have to learn and practice, like Empathic Listening (see: http:// 
  • Listen to the content of the person’s issues, not just the volume, tone or pace. 
  • Be authentic about receiving the person – have the intent to listen. 
  • Convey caring and instill hope.

Consider safety

  • Any reference to ending one’s life or threat of violence must be taken seriously.
  • Call security (5040) after hours and on weekends, or call the Centre for Student Development and Counselling (5195) weekdays between 9am-4:45 pm.
  • What to say to someone when you are worried for their safety: “I’m worried about your safety and I would feel better if you let me call the counselling centre to get some support for you.” 
  • If the person is off campus and you know their location, call 911 - ask for the Mobile Crisis Team (psychiatric nurse and police) to go to their home and assess risk of suicide. 911 an ambulance if suicide/harm is already in progress.

Refer when it’s FAIR

Refer out if/and when these 4 conditions apply. They are signals that more support is needed.

  • FEAR… if you feel afraid of or for the community member 
  • ANGER… if you feel angry - take a step back 
  • IGNORANCE… if you don’t know what more you can do for the person
  • RESPONSIBILITY and RESENTMENT… if you find that you begin to resent the responsibility you have assumed for the person

Emphasize key points:

  • State what you notice 
  • State the concern/reason 
  • Offer a resource 
    • Always be empathic and non-judgmental. 
    • Provide the person with tools to develop their own network of support

Setting boundaries and referring in concerning situations

  • Sometimes we get into situations that are outside of our expertise and we may feel the person needs more support than you can provide. It is ok to own that and recognize it. It is in the best interest of the individual involved. 
  • In this instance, it is important that we provide the individual the opportunity to get the appropriate support – either from a family member, GP, or it could be a counsellor.
  • What to say if you are concerned: “What I hear you describing is outside of my scope/expertise and I want to ensure you get the support you are looking for. Here are some materials/phone numbers/I will walk you over…”

Setting boundaries and referring in urgent situations

  • What to say of you think the situation is urgent or that the person needs immediate help: “You seem to be very upset and I am concerned about you and want to ensure you get some help. Can I make a call to one of the resources on your behalf or would you like to call?” 
  • Notice the difference in urgent situations is that someone is calling before the interaction is over.

PDF fileDownload the “Notice, Engage, Refer + Debrief Guideline”, a one-pager that outlines what kinds of distress you may notice, how to engage a student in distress, and steps for referrals.