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Graduate students take charge on mental health care

When Wendy Ingram was a graduate student, a dear friend in her program who was struggling with depression died by suicide. “From our devastation, we decided to build something that would promote change,” Ingram says, describing how she and eight other graduate students in the Department of Molecular and Cell Biology (MCB) at the University of California, Berkeley, went on to co-found the MCB Graduate Network in 2014. Since then, with support from the department, the peer network has promoted mental health awareness and offered a first port of call to MCB Ph.D. students as they navigate the pressures of graduate school. Science Careers spoke with Ingram, who is now a joint postdoctoral fellow in psychiatric epidemiology at Johns Hopkins University in Baltimore, Maryland, and Geisinger Health in Danville, Pennsylvania, about her own struggles and how trainees can create support systems for themselves and others.

Q: What is your personal experience with mental health?

A: My family has a history of bipolar disorder and major depressive disorder, so I know firsthand how damaging psychological disease can be. I started reading extensively on the topic as a teenager, and I initially planned to become a psychiatrist. By the time I reached graduate school, I was fully aware that the 20s is a high-risk period for the onset of mental illnesses, and that situations that are highly demanding and stressful—such as rigorous graduate programs—can trigger them.

So, even though my first year as a Ph.D. student was filled with happiness and excitement, I went to see Counseling and Psychological Services to touch base and establish care in case I would come to need it—which I did the following year, when I started experiencing depression and anxiety symptoms. It was very helpful that I was able to receive support immediately rather than having to wait 6 weeks for an appointment, as often happens to new patients in the U.S. health system.

I also knew that, when you are dealing with psychological illness, it can be challenging to recognize that you need help or to get the care that you need on your own. So, in my first year, I also set up a network for my closest friends and family to communicate among themselves in case I started dropping off the radar or saying things that seemed a little strange or worrisome, and I gave them permission to intervene. By having others that I love and trust keep an eye on me and empowering them to say and do something if they got the sense that something was off, I had created an incredibly important safety net for myself. 

Q: Did you expect the extent of psychological distress that you saw in graduate school?

A: To a certain degree, I expected what was coming for myself. But I was surprised by how many other people also suffered during graduate school. I ended up speaking to so many people who were struggling—friend after friend, person after person, in my cohort and in the cohorts below me and above me. That was tough, because I didn’t receive any clinical training or mentorship to help me deal with these situations.

Wendy Ingram

Courtesy of Wendy Ingram

What I found most effective was to be open about my own struggles. It was important to show my peers that I understood the struggles they were having, not only with mental health but also with stigma. Within academia, many people are reluctant to acknowledge mental health challenges because they are concerned that others will see it as a weakness. There is also a cultural stigma against leaving lab once or twice a week to go to counseling, as students have been told that they need to spend 16 hours a day at the bench. There’s also a bit of a legacy issue. Some faculty members went through graduate school so long ago that they don’t really remember what it felt like, or there is this idea that if they suffered through it, so should you.

It is true that graduate school is ridden with stressful and challenging situations that must be overcome. But this doesn’t mean that mental health challenges are something you should just live with. Sure, feelings of worthlessness and hopelessness are common in graduate school. But when they are persistent, they can be symptoms of depression that shouldn’t be ignored. I encouraged all of my friends who were struggling to address the issues head-on by finding their individualized ways to deal with stress and retain some level of happiness, and seeking psychological services if necessary.

Q: Did you ever worry that there could be downsides to being open about your own struggles?

A: As a trainee, I certainly have been conscious that when I disclose my family history and my own concerns for myself, often I have no idea how people are going to react. One reaction could be really beneficial, like, “Oh my gosh, I’m so glad to know this. I see Wendy and she just got this great paper out and she seems like she’s doing so well, but now I hear she is struggling, too. This makes me feel more comfortable to go and seek some help for myself.” But then a different reaction could also be, “Oh my gosh, why would she tell me that? I’ve lost all trust in Wendy’s ability to keep private information secret, and that also really explains why she only has one paper.” So, during graduate school, I tried to be very intentional about whom I shared information with, and how.

I still worry that talking about my challenges could be damaging. But now that I am a little more advanced in my career, I feel much more sure of myself and confident that talking about mental health conditions is the right thing to do. This is in part related to a memoir I read back when I was 16, in which clinical psychologist Kay Redfield Jamison describes her experience of having bipolar disorder. Seeing how she put herself out there in the 1990s when bipolar disorder was hugely stigmatized and yet went on to become recognized as one of the world’s experts in the field is both inspiring and empowering. And as it happens, I feel that in a way I have come full circle now, as Jamison co-directs the Mood Disorders Center where I am currently working.

Q: In your fifth year as a graduate student, you co-founded the MCB Graduate Network. How did you go about it?

A: Initially, after we lost our friend in 2013, a few of us just wanted to come together and figure out, if we could only do one thing to help others who are struggling, what would that be? We identified going into your third year, after passing your qualifying exams, as this drop-off point where you have a high risk of going under more extreme and lonely pressures. At the beginning of graduate school, you’re often part of a large student cohort, but as you move forward, you get to the point when you are essentially sailing off on your own. If you don’t have a supportive lab group and friend network, you could potentially start having difficulties without anyone noticing. So, my co-founders and I organized a student-only event designed for third-years where we shared the struggles that we and others faced, highlighted some warning signs, and conveyed the message that you are far from alone in suffering or feeling you don’t belong. We also shared strategies that worked for us to deal with stress, loneliness, depression, and anxiety. Participants loved it so much that in a post-survey, they requested a similar mental health event for each year of graduate school.

Participants also wanted access to peer mentors in case they felt unsure about how serious their struggles were or uncomfortable approaching faculty members or psychological services. We thought this was a great idea, but we were also terrified about the risk of saying something wrong in sensitive situations or just putting too much on ourselves. We reached out to Counseling and Psychological Services, which took some of the pressure off by helping us draw clear lines between what our purpose was and where it ended. They equipped the students who were interested in acting as peer mentors with intervention tools, such as active listening, peer support techniques, and a suicide prevention method known as QPR—question, persuade, and refer to professionals for help—that can be applied to acute depression and severe anxiety. It only took a few hours of training, and after that we felt a lot more adept and comfortable at helping our peers. Finally, we created a website to gather peer-recommended campus and community resources to help students cultivate their physical, emotional, financial, and mental health. 

Five years later, the MCB Grad Network is thriving and continues to evolve. The website has been refined, the peer mentoring is a much bigger and more consistent program with monthly check-ins, and the board members are planning additional activities to promote sustained cohesion of the incoming classes. It is important that we put in place as many lifelines as possible, and at different levels. For example, I am talking with faculty members at Berkeley, and here at Johns Hopkins, about ways to train faculty members to cultivate mental health awareness in their labs, spot signs of potential struggles in their students, and intervene before they may stop coming to the lab. In addition, the current MCB Grad Network members and I are discussing the possibility of creating an alumni bridge so that those who leave graduate school can maintain supportive structures in their lives as they move on in their careers. Sadly, these discussions were prompted by another tragedy: Recently we lost a friend and alumnus who was a phenomenal scientist, mentor, activist, writer, and drag performance artist who touched hundreds of lives. This loss highlights that more can and must be done, especially for those who may be at higher risk of developing depression and other mental illnesses under the pressures of academia and life beyond campus. 

Q: What advice do you have for others who want to set up similar networks?

A: In addition to mental health awareness and adequate training, it is critical that the first group of students behind peer support networks have a diversity of backgrounds and experiences to share, and that they are really committed to getting things off the ground. Then, a supportive administrative staff and faculty who are invested in promoting mental health in their students is also key. It was important to us to have student-only events to allow for more open and candid discussions, but we were regularly talking with the administrative assistants and faculty members in our department to establish with them that what we were doing was important, and to garner their support. From the beginning, the department helped us book rooms and refreshments. Cookies and coffee are not only a physical manifestation of support, but also a good way to recruit students to come.

Q: What would you say about the importance of cultivating mental health in academia?

A: I have always felt that taking care of myself is an important first step to then be able to take care of others. Coming up with and thinking carefully about what has worked for me and cultivating a space that would respect and support others has helped me take care of my friends and give back to the community. On a broader level, I hope that the MCB Grad Network and other sustainable initiatives will help change cultures within universities for the better.

Social support from people who understand the unique challenges and high-pressure situations that we put ourselves in for the love of science, and for the careers that we’ve chosen, is paramount. We should never forget that behind scientific pursuits are our minds, our hearts, and our souls, and that we can help one another in ways that we can’t help ourselves.

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