Sunday, April 28, 2019

Reintegrating into lab following a mental health leave

[From AR] These days, there is a greatly increased awareness and decreased stigmatization of mental health amongst trainees (and faculty, for that matter), which is great. For mentors, understanding mental health issues amongst trainees is super important, and something we have until recently not gotten a lot of training on. More recently, it is increasingly common to get some training or at least information on how to recognize the onset of mental health issues, and in graduate groups here at Penn at least, it is fairly straightforward to initiative a leave of absence to deal with the issue, should that be required. However, one aspect of handling mental health leaves for which there appears to be precious little guidance out there is what challenges trainees face when returning from a mental health leave of absence, and what mentors might do about it. Here, I present a document written by four anonymous trainees with some of their thoughts (and I will chime in at the end with some thoughts from the mentor perspective).

[From trainees] This article is a collection of viewpoints from four trainees on mental health in academia. We list a collection of helpful practices on the part of the PI and the lab environment in general for cases when the trainees return to lab after recovering from mental health issues.

A trainee typically returns either because they feel recovered and ready to get back to normalcy, or they are **better** than before and have self-imposed goals (e.g. finishing their PhD), or they just miss doing science. Trainees in these situations are likely to have spent time introspecting on multiple fronts and they often return with renewed drive. However, it is very difficult to shake off the fear of recurrence of the episode (here we use episode broadly to refer to a phase of very poor mental health), which can make trainees more vulnerable and sensitive to external circumstances than an average person; for instance, minor stresses can appear much larger. In particular, an off-day post a mental health issue can make one think they are already slipping back into it. In some cases, students may find it more difficult to start a new task, perhaps due to the latent fear of not being able to learn afresh. Support from the mentor and lab environment in general can be crucial in both providing and sustaining the confidence of the trainee. It is important that the mentor recognize that the act of returning to the lab is an act of courage in itself. The PI’s interactions with the trainee have a huge bearing on how the trainee re-integrates into his/her work. Here are some steps that we think can help:

Explicitly tell trainees to seek the PI out if they need help. This can be important for all trainees to hear because the default assumption is that these are personal problems to be dealt with personally in its entirety. In fact, advisors should do this with every trainee -- explicitly tell them that they are there to be reached out to, should their mental health be compromised/affected in any way. Restating this to a returning trainee can help create a welcoming and safe environment.

Reintegrating the trainee into the lab environment. The PI should have an open conversation with the trainee about how much information they want divulged to the rest of the group/department, and how they communicate the trainee’s absence to the group, if at all.

Increased time with the mentee. More frequent meetings with a returning student for the first few months help immensely for multiple reasons: a. It can help quell internal fears by a process of regular reinforcement; b. It can get the students back on track with their research faster; c. The academically stimulating conversations can provide the gradual push needed to think at a level they were used to before mental health issues. Having said that, individuals have their preferred way of dealing with the re-entering situation and a frank conversation about how they want to proceed helps immensely.

Help rebuild the trainee’s confidence. One of the authors of this post recounts her experience of getting back on her feet. Her advisor unequivocally told her: “Your PhD will get done; you are smart enough. You just need to work on your mental health, and I will work with you to make that the first priority.” Words of encouragement can go a long way -- there is ample anecdotal evidence that people can fully recover from their mental health state if proper care is taken by all stakeholders.

Create a small, well-defined goal/team goals. One of the authors of this article spent her first few months working on a fairly easy and straightforward project with a clear message, one that was easy to keep pushing on as she settled in to lab again. While this may not be the best way forward for everyone depending on where they are with their research, a clearly-defined goal can come as a quick side-project, or a deliberate breaking-down of a large project into very actionable smaller ones. Another alternative is to allow the trainee to work with another student/postdoc, something which allows a constant back-and-forth, and quicker validation which can lead to less room for mental doubt.

Remember that trainees may need to come back for a variety of other reasons as well. There are costs associated with a prolonged leave of absence, and for some trainees, they may need to come back before they are totally done with their mental health work. It's likely that some time needs to be set aside to continue that work, and it's helpful if PIs can work with students to accommodate that, within reason.

Finally, it is important for all involved parties to realize that the job of a PI is not to be the trainee’s parent, but to help the student along in their professional journey. Facilitating a lab environment where one feels comfortable, respected, and heard goes a long way, even if that means going an extra mile on the PI’s part to ensure such conditions, case-by-case.

[Back to AR] Hopefully this article is helpful for mentors and also for trainees as they try to reintegrate into the lab. For my part as a mentor, I think that a little extra empathy and attention can go a long way. I think it's important for all parties to realize that mentors are typically not trained mental health professionals, but some common sense guidelines could include increased communication, reasonable expectations, and in particular a realization that tasks that would seem quite easy for a trainee to accomplish before might be much harder now at first, in particular anything out of the usual comfort zone, like a new technique, etc.

Comments more than welcome; it seems this is a relatively under-reported area. And a huge thank you to the anonymous writers of this letter for starting the discussion.


  1. Thanks for this sobering article on a difficult topic. The same attitude from the PI would probably also be helpful in stressful periods to prevent actually having an episode or simply to not lose motivation.

  2. This is based on the assumption that "trainees" (I hate that word)
    a)want that level of intrusion, and
    b)are not equipped to self-advocate for what they need

    1. Hmm. I don't think any of this is particularly intrusive, but of course, anyone should feel free to self advocate for what they need or don't need at any time. I think the authors just wanted to provide some ideas for what such self advocation might look like. I think all parties would agree that communication and coming up with a collaborative plan is essential.

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