Mental Health in Academia: How to enact change

Postdoctoral fellow and activist Wendy Marie Ingram explains how she trains, educates and works with students and faculty to improve academic mental health.

In 2013, when Wendy Ingram was a PhD student at the University of California Berkeley, she lost a classmate to suicide. Only a few years later, during her postdoctoral fellowship at the Johns Hopkins Bloomberg School of Public Health (JHSPH), another of her close friends and colleagues took their own life.

As a response, Ingram (currently a postdoctoral fellow in psychiatric epidemiology) joined forces with other students to create networks at Berkeley and Johns Hopkins. She created talks and workshops that she gives to educate and train academics on mental health. To fight stigma, she has put together a series of video interviews in which faculty and staff members talk about their own struggles.

Her next step is to launch the non-profit Dragonfly Mental Health, which convenes the Global Consortium for Academic Mental Health. This initiative will design interventions that research institutions can use to improve mental health in their communities. “Action is my coping mechanism”, says Ingram, “I can't bring my friends back, but I'm going to do whatever I can to prevent others from being lost, and others from losing”.

Image credit: Veruschka Normandeau | (CC BY 4.0)

You have been giving mental health talks to departments in the US and now abroad, where you explain basic facts about depression. Why did you decide to focus on mental health literacy first?

When I lost my first classmate, the faculty seemed so petrified of saying or doing the wrong thing that they stayed in the lane that they felt most comfortable with, which was: “let's avoid this, and talk about science”. And I understand the impulse: if you have never swum in your whole life then suddenly you see someone drowning, there is hesitation, there's freezing. That's just a big part of what humans do in these situations. But to most effectively prevent suicide, you need to treat the underlying mood disorder. That requires having the language and knowledge to detect it in yourself and in others, so that you can address it before it's anywhere near the stage of suicidality.

Do you think education is enough?

No, not by itself. Education is easy! We can improve people's understanding and knowledge about mental health; this is the brain part. It's a bit of a trope but, as academics, we're very in our heads: it’s uncomfortable to go into our “heart space”, but it's doable, and it's actually essential for us to be able to take care of one another as a community.

When I give a talk, I explain that I’m doing it because I lost my friends and my colleagues. It crushes me every time, but I do it for them, and I think that's an important piece to recognize, and for the audience to recognize in themselves. They can see me standing on a podium, going from that heart space then back up into my head and saying: "This is what we can do about it.” It’s that combination that is key.

You helped create a 90-minute workshop where you train faculty in active listening and signposting, while also teaching them how to establish safe boundaries with students who struggle. How did this project come to be, and what has been the uptake?

Students and trainees don't have the permission they need to start conversations about mental health with their supervisors; but if a faculty member opens the door, they are more likely to walk through it. So we went to administrators at Johns Hopkins saying that we thought training all faculty in active listening skills would have the longest-lasting impact. And at first many people were worried and said: “Nope, you'll never get faculty to do this. Nobody likes more training.” Just “No, no, no”, an avalanche of “No.” But we were not one to take no for an answer; so nine students and trainees crammed into my tiny postdoc office, and started designing our own workshop.

At the same time, a core of about 20 faculty at my alma mater, UC Berkeley, volunteered to take this training. This was, unfortunately, a community who had just lost another student to suicide, so they were particularly motivated. And the comments that came back were out of control fantastic. So, we went back to the administrators at John Hopkins with a complete workshop and said: "These UC Berkeley faculty members found it valuable, can we please do it for everyone here?" That was less than a year ago, and now we have conducted workshops for half the departments in the Johns Hopkins School of Public Health!

Your talks and workshops invite or directly target faculty members. How has it been working with them so far?

Some are actively, positively supportive of student and trainee mental health: they feel confident expressing care and create protocols to manage mental health within their labs... That's not the biggest group, but most students know who those faculty are.

The majority of faculty is definitely well-meaning and really care about their students, but they are not projecting that effectively. They don't want to be invasive, they don't want to say the wrong thing, they don't have the language or the knowledge to really engage in those conversations. For students though, if it's not explicit, they are likely to believe that the faculty don't care – there is a disconnect between faculty’s intentions and student's perceptions.

And then there's a handful of faculty who say the things that students internalize: “I went through it and so should you, pull yourself up by your bootstraps, if you struggle it's your fault, it's a sign of weakness, maybe you don't belong here...” These people are the ones who unfortunately tend to be the loudest, the most brazen. The majority of faculty may not believe that, but if that majority isn’t actively countering it, students believe that everyone agrees.

How do you engage with faculty members who may not be on your side from the start?

A really important step to move this conversation forward is to try to see people for what they're capable of, rather than only for what you have seen them fail at. Some faculty are trying, even if they don't always say the right thing. We shouldn't give people a pass, but there's a lot of compassion that can go to those who are willing to try, even if they are not perfect.

I have this phrase that I learned in grad school: “Be curious, not furious”. When someone says something that's infuriating, I've learned a lot more by being really curious about where that comes from. Some of the faculty known to share negative thoughts about mental health have come up to me to reveal their own struggles; and often, this resulted in very deep, enlightening conversations. I'm not saying everyone is like that, but there may be openness even in those who are resistant at first.

Is this what prompted you to create videos of faculty sharing their own mental health journey as a way to fight stigma?

Yes. Students were telling me they felt faculty don't understand mental health issues because they've never gone through them. At the same time, faculty were coming up to me after my talks, saying “when I was struggling with depression, when I went through this phase where I had panic attacks”. So, I wanted to see if faculty and staff would be willing to put themselves out there, be vulnerable, step into the light and share their story and dispel this myth. As someone with lived experience myself, I thought that when you've gone through something really hard, you're much more likely to do something that could help someone have an easier time than you had.

What was the response?

I sent out a blanket email to every single faculty member in the School of Public Health at Johns Hopkins. And within a week, sixteen had agreed to be interviewed on camera: I never sent another email. I had the same immediate response when I brought the project to UC Berkeley.

These videos were incredibly transformative for the community; the feedback we got from the audiences was that it was more powerful because it was people they know, who they respect, who they already formed opinions about. If they don't know the person, or they don't think of them as a hero, they might be more willing to dismiss the message. It’s really important to tailor work around stigma to the community at hand.

On that point, all your interventions – such as your talks and your workshops – are both bespoke and strictly evaluated. Why are those two aspects so important to you?

I do not want to waste my time and I do not want to waste their time. I'm a mental health researcher: I could be doing a lot of different things that could be impacting more people, but I'm devoting time to this. So I always ask for feedback, and we adjust the interventions based on that information. To build interventions you need to follow universal, evidence-based principles; and then you must tailor your content to actually be meaningful for the community.

For example, for our workshop, we first get in a room with the key stakeholders of the community we’re working with, the chair of the department, the program coordinators, the faculty members who are already on board. We also get anonymized feedback from students – what they need in the department of mental health is very different from what they need in international health, when they spend years abroad during their PhDs for instance. We map out what kind of resources faculty in this community might want, and we tailor our handouts to this. After the workshop, we give the stakeholders a synthesized review of what the faculty felt, thought and said to help the department decide how to move forward in their community.

Overall, you have to speak to academics in their own language. I know they are highly intelligent so I'm not going to talk down to them. I know that they're trained to be critical, so I'm going do my homework, and get my content vetted by specialists.

Many people would also like to become advocates at their institutions: what advice would you give them?

Spot the mental health warriors in the community and collaborate with them. The key is to find allies and involve effective partners and advocates. None of what we’ve done at UC Berkeley and Johns Hopkins would have been possible without all the staff, faculty, administrators, and mental health clinicians who joined forces with us. We’re so, so grateful to them.

Then, organize, prioritize, coordinate and don’t hesitate. Talk to people who would not normally be interested in talking to you, so you know their perspective; find out what motivates stakeholders. In a little bit more of a resistant environment, decide whether resistant parties need to be circumvented, if direct interaction may be useful, or if you can go above them and get buy-in from even higher up.

Honestly though, what I’ve found is the higher you go, the more “death by committee” you’ll meet: "Let's have a meeting about it, let's have another meeting about the meeting, wait what's this meeting about?" You have to prioritize to get things done. My recommendation is, whenever you have a straight shot of "let's do this one thing, and make that happen", take that opportunity. If it’s important and impactful, it will spread. When a skeptic asks a faculty member they trust: "That mental health talk was really dumb right?" and they get “No actually, it was really informative” as a response, that is something that opens up their mind. More so than a bunch of students clamoring "everybody should care about us…”

So much of your work has been done as part of student groups: where are the institutions in this?

It might sound harsh, but we’re doing it ourselves because they’re not. At least not the right things and certainly not fast enough. We want to be able to tell them what we need, what we would like to have – not listening to students is a big problem. The worst thing is if a university is ignoring the problem, which a lot of them still are. But other problems occur when institutions ask already over-extended faculty, staff and administrators to serve on committees to address these issues without protecting their time.

However, more and more institutions are perking up and realizing this cannot be addressed through lip service alone. They're starting to actually put their money where their mouth is and hire people whose job it is to deal with student mental health. Unfortunately, some of these positions are being filled but they don't always have the power to actually make necessary changes, especially the changes that could protect people with the most severe issues. The truth is that I don’t know why mental health issues aren’t being adequately addressed by the institutions because I’m not in that role. But it seems to me like they need help. And I’d love to have more conversations to find out so we can address the problems together.

In your opinion, what do you think universities could particularly improve on when tackling mental health?

In my mind, mental health is a spectrum ranging from health to stress to distress to disease, all the way to crisis. My impression is that what gets the green light from institutions is often on the lower end of the spectrum, for when students are stressed or maybe distressed, but not at the disease or crisis stages. For example, we need to increase competent care for the folks who have diagnosable disorders, at hours that fit their intense schedules. In the US, when students are in crisis they get put on medical leave, which is this horrible double-edged sword where people can finally receive medical care, but they also often lose their insurance and their income.

I understand that change cannot happen overnight, that it takes time and money. And I understand that universities may have conflicting interests like budget or legal liability, and that they can get bogged down and lose steam. But stopgap measures are available. These are people's lives; my friends are dying and that's not okay. It’s that urgency and compassion that we seem to lose when you leave it solely in the hands of the universities.

What do you hope to achieve with Dragonfly Mental Health and the Global Consortium for Academic Mental Health, the non-profit and initiative you are starting?

We want to take the burden off the students and faculty: we want to bring in volunteers, lawyers, policy-makers, have the difficult conversations and review best practice. Then we can give institutions a package of initiatives and say: “This is the gold standard; this has been vetted and applied in other places. It’s 99% done for you, now review it, adapt it and actually implement it: because this is what is going to keep people alive.” We're doing this work for everyone in academia, but we're also doing it for the person next to us in the lab who is struggling: our friend, our colleague, our competitor even. That individual may not have tomorrow. Having that urgency, that individuality in mind, I think is one of the things that, for me, this nonprofit is all about. We matter. All of us matter, and we need to do better.

Wendy Ingram was interviewed by Elsa Loissel, Associate Features Editor, eLife.