Motivational Interviewing skills: Helping students experiencing mental distress and suicidal ideation

Motivational interviewing (MI) is a widely used training method that helps individuals create positive change. It has proven effective across various professions. I have provided this training in person for behavioral health professionals, executive leaders and educators. Each time I conduct the training, I use a different teaching technique depending on the audience. MI can also be beneficial for suicide prevention and help students experiencing mental distress.

College students are increasingly facing depression, anxiety and suicidal thoughts. According to a 2023 study, more than 76% of students experience a moderate or severe type of psychological distress. Each year, more than 24,000 college students attempt suicide, and 1,100 die by suicide. Suicide is the second leading cause of death among college students in the United States. Illinois ranks among the states with the highest suicide rates among teenagers, and on a national level 1 in 5 college students struggle with suicidal ideation. MI is an effective tool for supporting students experiencing mental distress or suicidal ideation.

Three mnemonics – RULE, PACE and OARS – can guide motivational interviewing.

RULE

1. Resist – Avoid immediately offering solutions when talking with a student. This can lead to “backfiring,” which happens when a suggestion doesn’t work to provide the desired outcome. Instead, resist giving advice or making judgements and keep an open perspective.
2. Understand – Discover the motivation behind the student’s behavior. For instance, if a student seems sad or withdraws from activities they once enjoyed, try to understand the underlying cause. Finding the cause of the behavior will help guide them toward a resolution.
3. Listen – Listening is one of the most valuable ways to support someone. Listening makes them feel heard and gives you the opportunity to assess the situation. Practice empathic listening by avoiding judgement, focusing on the strengths and using a person-centered approach.
4. Empower – Encourage the student to seek appropriate help. Empower them to seek positive changes and recognize their ability to overcome challenges.

PACE

1. Partnership – Approach the conversation as a collaboration. This can help calm the student and encourage them to be more open about their struggles. Instead of trying to be the fixer of the problem, provide perspectives that allow the student to come to their own conclusion.
2. Acceptance – Let the student know you accept them as they are. This builds trust and increases the likelihood they will confide in you.
3. Compassion – Showing compassion helps the student feel listened to and cared for. Mental distress leaves people feeling vulnerable. Showing compassion will bring a sense of comfort. Example, “I’ve noticed you have been missing class lately and you’ve seemed sad. I am here to talk if you are comfortable talking to me about it.”
4. Evocative – Encourage “change talk” by asking open-ended questions framed with Who, What, When, Where, Why and How, often referred to as the 5 W’s and H. Questions to ask include:
   • “I noticed you’ve been crying a lot the past few days. Is something going on that you want to talk about?”
   • “Have you done anything to help with what is going on?”
   • “You seem to be struggling with depression. Is there anything I can do to help you?”
   While some of these questions may be a Yes or No, following up afterward can prompt deeper discussion. Asking these types of questions helps the student reflect on their situation and may help them seek appropriate help.

OARS

The OARS mnemonic, is one of the most popular and encompasses the core skills of MI.

1. Open-ended questions – Using open-ended questions makes the student think more about the situation and encourages them to reach their own conclusions. The 5 W’s and H help facilitate deeper dialogue. Yes and No questions provide limited information, but these questions can serve as a starting point.
2. Affirmations – Give positive statements to affirm behaviors that create positive changes. Example, “It was great to see you turned your assignment in on time. I can tell you put a lot of effort into it. I appreciate your hard work!” Positive reinforcement motivates students to consistently move toward constructive choices.
3. Reflective listening – This involves repeating, paraphrasing or summarizing a conversation to promote deeper exploration.
   Examples:
   • “I heard you say you feel like you have nothing left. What do you mean by that? Can we explore that a little more?”
   • “I understand you have had thoughts about hurting yourself but do not want to act on them. What are some things you can do to help you not act on those thoughts?”
   • “It sounds like you are going through a tough time. Is there anything I can do to help you?”
   This is an application of reflective listening and can be used as transition points throughout a conversation, making sure there is clear communication between you and the student. For instance, in the one example above, the student mentions they have thoughts of hurting themselves. The response given was reflective and followed up with encouraging ways to prevent suicidal thoughts.
4. Summaries – You can also summarize a statement showing clarification with a student: “I just want to make sure I understand this correctly. You’re having trouble concentrating because of the constant stress and you don’t want to seek help because you think it’ll make you look weak. Please tell me if I am understanding that correctly.” Providing these kinds of statements lets the student know you want to understand and you are actively listening.

The three mnemonic’s can be used as a guide when conducting Motivational Interviewing with a student. They are non-linear, which means you do not have to follow each in order and can adjust your statements based on the situation. For instance, you may be reflective listening and then provide compassion and acceptance based on what the student said. However, if you feel the student is in immediate crisis and you think they cannot be safe, call 911 or an appropriate behavioral health professional. In these instances, it’s important to get appropriate help immediately.