PhD student with mental health issues and bad performance

Question

One of my PhD students told me during a supervisory meeting that they have been struggling with anxiety and depression and self-referred to the university psychological support. They asked me not to share with anyone and I didn’t.

Moving forward eight months and their penultimate year, their performance has declined to a degree that they might fail the PhD altogether. I tried to support with regular meetings, breaking tasks, teaming with other students, nothing seems to help pick up the pace.

Normally, at this point, I would set in place a special process: an independent committee is set to review progress regularly and set objectives and I’m only one of the three members. This is the formal process and usually works very well to address the progress issues but also puts more stress on the student because there is a stick at the end: the committee could decide to remove the student from the PhD program.

So, here is my trilemma:

• If I go on with the process, I don’t know what this will mean for the student’s health. There might be a note on their record from the psychological services to instigate special treatment, but I’ll not know beforehand.
• If I discuss this with the support team in hypothetical terms, it would be very easy to understand which student it is since my group is small and that student is the only one I have in that particular phase of the PhD. This would violate his explicit request.
• If I don’t do anything, the certain outcome is that the student will go unprepared to the viva presentation (if they manage to prepare a thesis) and fail.

Anyone has experience how to deal with a situation like this? Any resources?

Update: After laying out the options to the student, they decided to leave the program. It seems this was something they were planning for even before my talk. I am not sure if the plan to leave the program was also a contributing factor to the bad performance or luck of effort.

Answer 1

Be forthright with the student about what they are facing. Explain the various contingencies. They may be unaware or ill-informed. You could ask them which path they would prefer you to take... True, they may not be the best judges of their own best interests, or may not be able to act, but you can ask.

In particular, probably you indeed should not share information that you'd promised to keep confidential, short of issues like potential self-harm or harm-to-others. At the same time, it may be that your university has fairly strong guidelines about your supposed responsibilities in a situation like this. At least try to read up on them... whether or not you think it is humane or wise to comply. I suggest that you keep in mind that the university will be "covering itself" legally, first of all, with concern for students and faculty somewhat subordinate... so it is non-trivial to see what the truly best action will be.

In any case, I think it would be good to avoid allowing a disastrous thesis defense to occur, especially if there is no room for a second attempt (as at my own university). Being late but doing ok is vastly preferable to being on time and catastrophically failing...

No, I do not mean to suggest that laying this out for the student will magically transform them... but that it is fair to inform them of consequences of this and that, and ask them what route they'd want you to take.

And, by the way, is "removal from the program" merely (!?!) loss of funding? In my university, it is possible to continue to register (after everything but thesis and defense are done) without cost... and, thus, without necessarily having financial support from the program.

Answer 2

It can be incredibly difficult for a student to discuss any sort of health issue with his/her advisor or committee members and yet doing so can make all the difference.

Personally, I left my PhD program after two years rather than discuss my ongoing health problems with my advisor. I deeply regret that decision. I knew my advisor and committee were unhappy with my progress and I simply could not bring myself to talk to them about the health issues which were behind my lagging performance. By opening a dialogue with your student you may be throwing them a lifeline, a chance to open up and communicate about the relevant issues and find a solution.

To this day my former advisor has no idea that I was, and am, seriously ill and struggling with debilitating health problems. I "lose" at least one full day per week to illness. In graduate school losing a full day every week was a substantial liability. I am considered legally disabled and yet never shared that information with my advisor or department because I was scared about how they would perceive me and how it would affect my career.

Last year I finally received my M.S.(but sadly no PhD). The only way I was able to do that was to work with my university's student disability services office. Does your institution have an office for disability services? I would strongly encourage your student to seek their assistance and you may also want to consult with them and seek their advice on this issue.

Answer 3

As someone who was the student in a similar situation, I can speak from personal experience about what I wish my advisor and program had done (what they actually did will be omitted here to protect the guilty). My experience was in the US, so there may be some differences elsewhere.

If you are debilitated by a condition that impairs your intellectual functioning, it is difficult if not impossible to think clearly about the future and make good decisions. The student is evidently aware that things are not going well--as I was--but may not have the physical or emotional resources to be able to seek out options and plan ahead. This is compounded by all of the usual emotional stress and guilt of underperforming in grad school. The fact that the student brought it up to you is a cry for help, and you are doing the right thing by trying to act in the student's best interest.

Although it might be the case that the student really does not want to finish the degree (or isn't "PhD material"), it's impossible to tell as long as the student is sidelined by disability. So your first responsibility as their advisor is to protect the student from any future academic consequences for failing to perform now. This may involve your school's disability office, who might have standard accommodations for this situation. It may also involve working with the department to ensure that the student's current performance is not used as a justification to penalize the student if they later resume their program.

Your second responsibility is to do what you can to provide the student with some options to take a time-out and recover so that they can function well enough to make a good decision about when and whether to resume their program. From what you've said, the student seems to be dependent on the university for their living expenses and possibly also their healthcare as well. If this is the case--especially if you believe that the student would have difficulty finding or holding a job--the humane thing to do would be to offer some options so that the student can still be employed by the university and continue to have access to healthcare.

I emphasize that the student's health issues are ultimately their business and their responsibility. But since the student entrusted you and your program with their academic future, I believe that as the student's advocate in the academic world, the advisor has an obligation to protect the student in a situation where they are unable to fend for themselves.

Answer 4

To add to Paul Garret’s answer:

It is a common feature of many psychiatric disorders that those suffering from them fail to seek help when they should, be it because they do not notice or cannot make this step. This even applies to those who are aware that they are generally suffering from these problems and have sought help before.

Therefore the most important thing to do seems to be to talk to the student and find out whether they got all the professional help and support they need, more specifically:

• Share your observations on their performance.

• Tell them that you are worried about their mental health and have the feeling that they are currently suffering from a severe episode, phase, etc. If applicable, tell them that you feel they need professional help if they are not consulting it already.

• Ask how you can help them. If the PhD programme or your university have specific mechanisms to accommodate such students (check before), offer to help them to make use of them.

• Ask them whether they are fine with you consulting with others about the issues in general (thus breaking anonymity indirectly at best) or specific terms.

Since they confided in you, they should be okay with this; they may even have confided in you so you can keep an eye on them from this perspective (without telling you).

Answer 5

It is a very very important problem which is much more common in academia than is usually thought.. There should be opportunity to make a break in PhD, say for one year, for getting adequate health treatment, and then continue. Some universities allow this (e.g., in Netherlands).

If problems persist for eight months, it means university psychological help does not help. The person need to see a doctor, psychiatrist, who would prescribe suitable antidepressants. A PhD adviser is not a mental health professional, but to give advice to see such a professional is a wise thing to do.

A person could lose years, sometimes dozens of years, because of depression..

As a cautious remark only: At the same time, sometimes depression is due to inability to accept the reality. Was the person strong enough to do science and fulfil PhD studies before having health problems? If yes, antidepressants or other professional treatment will help. Otherwise, maybe to try to find work which do not require PhD? After PhD, nowadays there is almost no chances of permanent employment in academia: years of postdoctoral research with even higher level of anxiety. It may be better to stop earlier.

Answer 6

I think it's worth pointing out that it is very likely possible to "save" the student. The argument being that the student was already pre-selected by the admission committee and hence likely to succeed, including being able to overcome their present difficulties. You also note that their performance has declined, so in the past they did perform better. Therefore the student was at some point in time capable of succeeding. A talented person does not become untalented easily, but it is not uncommon to lose motivation to apply that talent. In a situation like the one you describe, I would suggest that not squandering the talent is important enough to go to lengths in restoring the student's motivation. So I would recommend against allowing the student to wash out: The third option would be equivalent to this, and the second option as well if you feel that the independent committee is unlikely to give the student a fair chance. Moreover, sunk cost fallacy notwithstanding, much has been invested in this person already - it is best for everyone if they turned things around and succeeded, rather than failing.

Your student has already taken the correct first step of seeking counseling. You don't mention the type of counseling, but it's worth looking into support groups with other graduate students. I think the most useful thing with regards to the student recovering is being able to share the burden with other students - some people are fortunate in that they are good enough friends with others in their group or fellow students in other groups, to the point where they feel comfortable commiserating and seeking serious advice. I will go out on a limb and predict that your student does not have many good friends who are also graduate students. If your university's counseling unit provides support groups for graduate students, this can effectively bootstrap the process by getting the student to meet with peers in a confidential situation, obviating the slow and difficult process of learning to trust a new friend organically.

However, if the defense is months away, I think it is best abandoned. Some people, with proper help, can just "snap out of it" - but many cannot. Usually there is a lot of mental crud that needs to be processed for the student to go from being crushed by stress to becoming determined to overcome it. With proper support it would take about 1-2 years. If the student is really far gone, it may be advisable to take a break for a few months (such as a leave of absence). After that the student will need time to recover, and after recovering they will still need to bring their thesis up-to-date and prepare or re-prepare for the defense. I don't think you can count on all this happening in 8 months. It's certainly possible, and if you have no option of postponing the defense (such as due to funding) then it's worth a try. But if you have the luxury of time the odds improve significantly if the defense is at least a year out.

For handling the immediate situation, your university may have an Ombudsman or similar office (perhaps human resources would be the place to start) that provides advice for such situations. This may help navigate matters like negotiating with the committee.

With regards to the impact of the process, if done appropriately the impact should be positive. There's a lot of variables, such as the student's precise state, the feasibility of the goals set, and the attitude of the committee. However, there is nothing wrong with having a stick. The stick is your friend. The challenge of graduate school is great, and difficult to overcome with only a stick or only a carrot. You really need the combined effect of the two. Withholding the stick would be a disservice to the student. Of course the student must be ready for it, otherwise instead of perceiving the stick and moving away from it, they will perceive a wall of sticks surrounding them and give up entirely. This is why it's important for a counselor experienced with graduate students to work with the student first. After the student has regained some measure of stability, they may be ready for the formal process, or it may turn out not to be needed after all.

A useful thing you could provide here is to freshen up the carrot. It would seem obvious that finishing a PhD is much better than failing. But to a depressed or anxious person, impostor syndrome can paint some wild pictures of their future. They will always want to imagine themselves to be the one legendary failure. However, there are certain facts that even impostor syndrome cannot easily obscure: Statistics about unemployment for PhDs, incomes, skills, accomplishments up to now, and so on. You are in the best position to see these clearly in your student. You can approach the subject constructively by framing in terms of the student's career plans. These should be seriously considered anyways in the year preceding graduation. Likely the student feels they have no career prospects or hopes at all - but the fact is that this untrue. Even a failed graduate student still has above average skills and talents, and above average career prospects. To say "there's no job I could possibly get" is unrealistic, surely there is something, even if depressingly low status. You can start there and gradually move the target up based on rational, objective indicators such as skills, job descriptions, etc. I've heard of people bringing their resume to the university's career advisor, and saying "if I didn't do anything else, how bad would be the job I could get?" Often it is really not that bad. And then you realize you don't have to do nothing, you can do a little bit to improve your situation, and the job prospects get a lot better. And if you improve a bit more, it's even better... And that's how you end up to deciding to just finish the PhD, defend it properly and be done with it. So explicit planning of post-graduate career plans can be very helpful, possibly critical, here. Indeed, why bother finishing PhD if not for the things you would do with it after? I suspect your students has thought little about what they plan to do once they receive their PhD, they are too busy thinking about what they'll do if they fail.

Of course, this must be done with a measure of prudence. An already distressed person cannot easily have a robust discussion about career plans any time. They must be mentally prepared for it. So you have to approach the subject gently. Hopefully, you have enough experience and knowledge of the student's character to gauge this.