Universities need to follow a solution-based approach to adequately address mental health and wellbeing among doctoral candidates. This includes providing appropriate support structures and developing an understanding of the diverse reasons that lead to such challenges for doctoral candidates. EUA-CDE Steering Committee member Barbara Dooley shares her perspective regarding the overall relevance of the topic and how to tackle it.
Over the next few weeks, The EUA-CDE Doctoral Debate will focus on the mental health and wellbeing of doctoral students and the importance of addressing this issue from an individual, institutional and societal perspective. Wellbeing and mental health tie in with the traditional focus of EUA-CDE regarding the professionalisation of doctoral education in Europe, in that there is an institutional-level responsibility to provide support and training for early-stage researchers.
Manuela Schmidt and Erika Hansson of Kristianstad University in Sweden propose a student-centred approach to meeting the needs of doctoral students, which will lead to the enhancement of doctoral students’ wellbeing as a long-term goal in order to improve it, as well as better productivity.
To put mental health into context, it is important to start with some key definitions such as mental health, mental disorder and resilience. Resilience is key to navigating the stress and uncertainty that doctoral students can encounter. The following definitions are taken from The Lancet Commission on global mental health and sustainable development:
“Mental health: The capacity of thought, emotion, and behaviour that enables every individual to realise their own potential in relation to their developmental stage, to cope with the normal stresses of life, to study or work productively and fruitfully, and to contribute to their community.
Mental disorder: Disturbances of thought, emotion, behaviour, and relationships with others that lead to substantial suffering and functional impairment in one or more major life activities, as identified in the major classification systems such as the WHO International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders.
Resilience: The capacity of individuals to adapt to adversity or stress, including the capacity to cope with future negative events.”
Epidemiological research worldwide has indicated a concerning growth in the prevalence of mental health issues, particularly among young adults - indicating negative psychosocial, educational and vocational consequences at the individual level, as well as a weighty social and economic cost. This is shown in the work of Patrick McGorry, Professor of Youth Mental Health at the University of Melbourne in Australia and Executive Director of Orygen, The National Centre of Excellence in Youth Mental Health.
Coupled with this is the widespread and increasing prevalence of psychological morbidity among higher education students, representing a neglected public health issue, which holds major implications for campus health services and policy development. Recently there has been an increased focus on the mental health and wellbeing of doctoral students globally with organisations in the UK, the USA and across Europe acknowledging the mental health challenges experienced by graduate research students.
Many universities have well developed services for undergraduates but provide little or no structured information regarding accessing available resources for their doctoral community. Part of the issue with regard to doctoral candidates lies with their status. In some universities, doctoral candidates are considered students. In others they are considered employees with a contract and, in another category, the doctoral candidate is treated as an academic in the institution whilst also completing his or her doctorate. These very differences can lead to confused pathways of care for doctoral candidates when they encounter mental health difficulties.
The very nature of the doctoral experience could increase the risk of psychological distress. For some doctoral candidates this experience includes: poor supervision, conflict with supervisor or supervisory team, financial stress, lack of sleep, poor diet, balancing the need to work and conduct doctoral research, if not funded. Additional pressures include: completing the doctorate within a specified timeframe and external pressures, such as publishing, funding, career prospects, etc. - none of which are going away any time soon.
This is echoed in a recent Vitae report listing the following additional factors affecting postgraduate researchers’ wellbeing: lack of clarity with regard to what is expected as part of the research process, limited feedback on progress and expectations of high achievement and high workloads. It is a combination of risk factors rather than any single risk factor that can result in, or exacerbate, mental health issues among doctoral students.
The following reflection from a doctoral candidate captures many of the issues that published studies report. “The research environment itself can be a negative one, with little or no support for students struggling with mental health issues, particularly depression or anxiety. Even the day-to-day stresses of struggling through a difficult research project is often unsupported by facilities within the department, or even other researchers, and no information regarding accessing available resources within our higher education institutions.”
Doctoral students are very important to the research output of a university system and as such supporting them is key to strategic missions. Therefore, universities need to look beyond risk factors and focus on constructive solutions. To ensure that doctoral students are supported, universities need to take both a top-down and bottom-up, solution-focused approach. At the top, universities need to develop institutional-level structures, policies and practices to provide clarity to all involved in doctoral education.
Research points to the supervisor as key. Supervisor training should include how to identify when a doctoral student is struggling, having a constructive conversation and signposting them to appropriate support. Supervisor training should include not only good practice in supervision and feedback, but also mentoring more broadly on career pathways and where they fit within the organisational structure, areas that many doctoral students struggle with.
At an individual level, doctoral candidates themselves need to be made aware of the signs of mental health difficulties and seek help early to ensure a good outcome. Seeking help and timely intervention have consistently been shown to lead to better outcomes.
At a broader system level, institutions need to provide appropriate training for all relevant staff with roles in the wider mental health support system to understand the needs of doctoral students. Furthermore, institutions need to develop an evidence-based approach by mapping demand and systematically collecting empirical data to understand when and how to support the doctoral community.
All views expressed in these articles are those of the authors and do not necessarily reflect those of EUA Council for Doctoral Education. If you would like to respond to this article by writing your own piece, please see The Doctoral Debate style guidelines and contact the CDE team to pitch your idea.
While questions of mental health and wellbeing are present in society in general, universities have a unique responsibility to protect students, doctoral candidates and staff from the causes of mental health issues and promote their wellbeing. Doctoral candidates, in particular, are at risk as they are under great pressure to succeed, may be enrolled in a programme in a country that is not their own, and may not know where to find help as many resources are addressed to “students”, and not doctoral candidates.
In addition, there is a lack of solid information on the topic and terminology surrounding the issue may be unclear and require a conceptional revamping. This contributes to slow progress in the debate. That is why EUA-CDE has gathered some of the best experts from our community across Europe to talk about mental health and wellbeing in The Doctoral Debate. The authors of our articles have provided explanations, shared perspectives and experiences, as well as recommendations.
Katia Leveque and Anneleen Mortier from Ghent University clear up the conceptional confusion by addressing the difference between mental health and wellbeing, explaining why this distinction is so very important. Barbara Dooley, CDE Steering Committee member, shares perspectives from the institutions regarding the overall relevance of the topic and suggests how to tackle it. Janet Metcalfe and Sarah Nalden from Vitae talk about what is being done in the UK and what other institutions across Europe can learn from this experience. And Mathias Schroijen from Eurodoc shares a view from the side of doctoral candidates and describes the issue from different national contexts in Europe.
At EUA-CDE we feel that it is important to openly discuss this issue and we will be happy to receive feedback on these articles from the CDE community. We are looking forward to your perspectives and experiences and we hope you enjoy and learn from this month of reading on mental health and wellbeing on The Doctoral Debate.Read more
World-class research asks for healthy and supportive work environments that allow researchers to flourish. The organisational benefits of high levels of wellbeing and good mental health in employees are well-known: better performance, less turnover, less absenteeism, less presenteeism and more organisational commitment. However, compared to the non-academic sector, universities are lagging far behind in terms of investments in the wellbeing and mental health of their doctoral researchers and academic staff. This lag is unfortunate as the European Union explicitly acknowledges that mental health is a key resource for the EU’s success as a knowledge-based society.
Is this due to a lack of need in academia? When exploring social media, the emerging picture suggests a pressing need: academics provide testimonies of stress, depressions, anxieties, addictions, burnout, suicidal ideation and suicides. According to some, the frame of “a mental health crisis in academia” is warranted.
As a reaction to the increasingly voiced concerns about wellbeing and mental health of academics on social and other media, more and more universities in Europe have put wellbeing on their policy radar, either as a totally new policy objective or as a policy objective in need of higher priority. In several universities, surveys and monitoring devices are set up, and prevention and action plans are developed or extended.
In the light of these recent developments, we call for some caution in the framing of “wellbeing” and “mental health” as these concepts refer to delicate and sensitive issues. When setting up programs, universities mostly use the framing of “wellbeing”. The terminology “mental health” is expressed far less, which might be related to the stigma and taboo surrounding it. Contrary to “mental health”, the use of a broad umbrella concept such as “wellbeing” has shown to ease the mobilisation of a critical mass of management support for initiating and adopting action programs. In addition, it might also ease the acceptance of action programs by those for whom they are developed. As categorising well-meant initiatives under the “wellbeing” umbrella has merits for its mobilising capacities, accurate reflections on term usage is in place. We’ll just initiate a few reflections.
First, in many European countries, the concept of wellbeing has no official definition. Across Europe, the conceptualisation of wellbeing differs. The European Agency for Safety and Health at Work identified as many as 11 different terms in use to describe wellbeing at work. General wellbeing at work might cover physical and mental wellbeing, psychosocial issues and the working environment. At a very high level of generalisation, all conceptualisations of wellbeing refer to an individual’s positive evaluations of his or her life, as it includes positive emotion, engagement, satisfaction, and meaning. Such broad definitions enable the understanding of wellbeing, but offer no clear guidelines for research, policy or action.
Second, as for the concept of mental health, definitions vary depending on cultural differences, subjective assessments, and competing theories and paradigms. Depending on the definition, there is an assumption of a certain level of pathology. Differences in the level of pathology refer to differences in “normal” or “non-clinical” mental health status versus “abnormal”, “pathological” or “(sub-)clinical” ones. Depending on the conceptualisation, another terminology is used to indicate mental health: “distress”, “issues”, “problems”, “disorders”, “illness”, “disease”. One consequence of this lack of agreement on the conceptualisation of mental health, is that the same concept, for example “depression”, might refer to very different levels of pathology, ranging from a single, transient and normal depressed feeling, to a severe, chronic and psychiatrically diagnosed depressive disorder. Needless to say, this might lead to miscommunication, misunderstanding, the hollowing out of concepts and the downplaying of severe emotional pain and suffering as a simple feeling of sadness.
Third, within occupational wellbeing research, researchers have mostly studied job outcomes (e.g. job satisfaction, absenteeism) and health outcomes (e.g. depression, emotional exhaustion) independently. Most studies have focussed on the causes of the outcomes, not on the interrelatedness of the outcomes themselves. Many people assume (often implicitly) that job and health outcomes are highly correlated. For example, many people assume that high job satisfaction is highly and positively linked with general mental health. But existing empirical evidence shows that the correlation is not as strong as usually assumed. As a consequence of the assumption, some organisations wipe out the possibility of mental health problems in their work force, using the argument that everyone is happy with their jobs, as their satisfaction surveys show. Another consequence of some assumptions made about the interrelatedness of outcomes, is that well-meant action programs might succeed in triggering desired effects in one outcome, while simultaneously triggering undesired effects in another outcome. To illustrate: an initiative aimed at reducing absenteeism might be very effective in lowering absenteeism statistics but might simultaneously trigger higher levels of presenteeism in the organisation, especially when underlying problematic working conditions are not adequately addressed.
In sum, universities that aim at efficient and effective management programs that support doctoral researchers and academic staff to flourish, might benefit from thorough reflection on how wellbeing and mental health are explicitly and implicitly conceptualised within their organisation. On top of that and more importantly, they should reflect on the (potential) consequences of these conceptualisations in terms of individual vs organisational responsibility, and in terms of approach. When work stress is reformulated in terms of a pathology or disease, it will trigger a different approach than framed in terms of psychosocial stress. The first will bring clinical psychologists, psychiatrists and medical specialists to the front stage, the latter will bring in human resources managers, job coaches and organisational change managers. The framing of wellbeing and mental health at work is not at all innocent: the concepts are real in their consequences. Nomen est omen.Read more
Earlier this year, Vitae, together with the Institute for Employment Studies (IES) and Professor Katia Levecque from Ghent University, were commissioned by the (then) Higher Education Funding Council for England (HEFCE) to explore wellbeing and mental health and associated services for postgraduate researchers within the UK. Our findings revealed a mix of issues that need to be addressed.
Professor Levecque’s 2017 study on the mental health of doctoral researchers in Flanders identified that 32% are “at risk of having or developing a common psychiatric disorder, especially depression.” In the UK there has been a lot of attention recently on the mental health of undergraduates, whereas much less attention has been paid to the wellbeing and mental health of doctoral researchers - and even less on research staff. But doctoral degrees are stressful, and arguably doctoral researchers are potentially at a higher risk of developing a mental health condition than undergraduates.
The academic culture of high achievement and expectations of high workloads creates an environment in which wellbeing is more likely to be at risk and doctoral researchers may feel less able to talk about these issues, which can lead to a devastating impact on an individual. The UK’s biennial survey of doctoral researchers (PRES 2017) revealed that although more than 60% of doctoral researchers were satisfied with their work-life balance and 85% felt that their degree programme was worthwhile, as many as 26% of respondents had considered leaving or suspending their degree programme, with a concerning 60% of doctoral researchers with a mental health condition more likely to have considered leaving or suspending their studies.
The issues uncovered
We studied the policies and provision related to the wellbeing and mental health of doctoral researchers at ten UK universities through interviews with key staff and focus groups with doctoral researchers.
Discussions amongst professional support staff within doctoral schools, student support services and faculty recognised that some groups of doctoral researchers were potentially more vulnerable to developing poor mental health than others. International doctoral researchers were regularly singled out. Staff recognised that doctoral researchers coming to the UK from countries with very different cultures could experience a combination of risk factors, such as adjusting to a new culture, potentially working in a non-native language, less access to family and friend support, finance and visa issues. Many Asian countries have cultures in which it is difficult to acknowledge mental health issues. Other significant vulnerable groups identified were isolated researchers, part-time researchers, researchers with disabilities and researchers with family or caring responsibilities.
A further issue identified was that whilst doctoral researchers are registered as students in the UK, most doctoral researchers did not identify as students and did not relate to key institutional messages about supporting student wellbeing and the importance of good mental health. Despite significant promotion of related support services to all students, some doctoral researchers reported feeling bewildered by numerous sources of support – partly attributed to their perceptions of “falling between student and staff”.
With these overlooked messages around student support, the quality of a doctoral researcher’s relationship with his or her supervisor/s becomes even more critical to wellbeing. As the primary point of contact, supervisors can and should play a critical role in ensuring the wellbeing of doctoral researchers. Difficulties in the supervisory relationship can be highly stressful but, even in the most positive supervisory relationships, doctoral researchers may feel uncomfortable about raising wellbeing issues. Supervisors should know when and how to intervene, and where to direct their researchers for appropriate support. Most supervisors, however, lack the appropriate training and support to do so confidently.
What can institutions do?
Universities UK has recently developed “StepChange”, a mental health framework encouraging a whole institution approach to mental health in the higher education sector. The language of the framework is primarily focused on undergraduate students but, with the associated resources, provides a very helpful process to develop institutional strategies to support the wellbeing and mental health of doctoral researchers with an aim of prevention and early intervention.
In practical terms this means that universities should:
invest in wellbeing and mental health support and resources to meet expected doctoral researcher demand and integrate this as an integral part of researcher developmentprogrammes;
provide mental health literacy training for supervisors, including support for the identification and early intervention into the wellbeing and mental health of doctoral researchers;
provide researchers with a safe and supportive environment where they can ask for help and mental health literacy training so they know when and how to do so; and consider targeted support for at-riskpopulations;
signpost wellbeing and mental health support services specifically to doctoral researchers, reviewing and monitoring the effectiveness and demand for these resources andactivities.
For research institutions to provide a safe working environment for all researchers, which supports their wellbeing and mental health, commitment by institutional leadership is needed, together with systemic cultural change across the academic environment. Our current academic culture of high expectations, high achievements and armour-like resilience is not particularly conducive to feeling in a safe enough environment where such vulnerabilities can be exposed. Imposter syndrome – internal fear of being exposed as a “fraud” - is common in the academia environment (affecting men and women equally) and more likely at the early career level. In the current landscape of increasing competition for fewer academic contracts, the perceived fear of risking career advancement and credibility by revealing mental health issues is understandable.
In the UK, the wellbeing and mental health of our researchers is getting increased attention. Since the Vitae report, the Office for Students and Research England has provided £1.5M (€ 1.68 M) in competitive funding for 17 projects in English universities over the next two years aimed at improving the wellbeing and mental health of doctoral researchers. Vitae and Universities UK have been commissioned to evaluate the impact of this funding programme, identify good practice and facilitate the sharing practices and experiences across the UK academic sector. The aim is to support the practicalities of implementing wellbeing and mental health initiatives across the sector. Projects include identifying needs, developing peer support and mentoring programmes, integrating wellbeing into researcher development programmes, developing supervisory resources and improving signposting and links to National Health Services (NHS).
A current UK consultation relating to the independent review of the Concordat to Support the Career Development of Researchers will provide a prime opportunity to consider how the current research culture is impacting on the wellbeing and mental health of researchers. Vitae members are able to join a Researcher Wellbeing Community.
There is good evidence that helping people thrive by providing a healthy, motivating and high-performance work environment helps produce a happy, engaged and productive workforce. Effective management of mental health in the research environment (and in industry), will not only boost productivity and performance, but can have a positive impact on progression and retention too. To produce world-class research, we must provide a healthy and supportive research environment that allows the new generation of researchers to flourish.
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