Oby Ukadike: Content warning, during this episode, we discuss experiences with depression, anxiety, and briefly mentioned suicide. We acknowledge this content may be difficult for listeners and encourage you to care for your safety and well-being if you choose to listen to this episode.

From the campus of Harvard Medical School, this is ThinkResearch, a podcast devoted to the stories behind clinical research. I'm Oby, your host. ThinkResearch is brought to you by Harvard Catalyst, Harvard University's Clinical and Translational Science Center, and by NCATS, the National Center for Advancing Translational Sciences.

Welcome to episode four of our series on mental health and medical training and graduate education in collaboration with the Mind Project at Harvard University. Today we dive into the ways in which institutions can consider creating more accommodating and inclusive research environments.

Additionally, our podcast today offers strategies for how you may approach your institution if you feel that your mental health is not being prioritized.

We are joined by Dr. Zoe Ayres, head of research and development at Figura Analytics Limited, and Dr. Juanita Limas, advisor and research scientists and molecular pharmacology at Eli Lilly and Company.

Hi, Dr. Limas and Ayres. How are you? Welcome to the show.

Zoe Ayres: Good, thank you.

Juanita Limas: Good, nice to be here.

Oby Ukadike: Great to have you both here. Before we jump in, could you walk us through your career paths, but also how you met each other.

Juanita Limas: My name is Juanita Limas. I'm a first generation college student. I'm originally from Des Moines, Iowa. Both my parents are Mexican. I'm Mexican-American. I have a very unconventional career path.

I went to college, I joined the Peace Corps. I was a former Peace Corps volunteer. I served in Nicaragua for almost three years as a community health education volunteer, came back to the States, got my master's degree and then taught at a community college for almost a decade before I decided I wanted to go back to school again and get my PhD.

So I just finished up my PhD at the University of North Carolina at Chapel Hill last year and started a great job here at Eli Lilly as an advisor research scientist in the molecular pharmacology group.

Zoe Ayres: Hi, I'm Zoe. I have an interesting route to where I am today, I think so I did a forensic science undergraduate degree, and then I went on to do a master's degree, which is pretty typical in the United Kingdom where I'm from. I did that in analytical science. I then went on to do a PhD in electrochemical sensor development at the University of Warwick where I really then started to get into diversity and inclusion work and things like that I then did a postdoc for a year before transitioning out to industry.

I worked in the water industry for a couple of years, and now I'm head of research and development for an industrial company. So I've gone from forensic science, which I thought was going to be my absolute bag and I hated it, and have ended up in a completely different area now, which is more like nanopore sensing technology. So quite an interesting ride to there I guess.

Juanita Limas: Zoe has been sort of doing mental health work way before I had come into this. I had been following her on Twitter, and she had a series of infographics that she put together about different population groups regarding mental health. So she had an infographic about mental health with research scientists, mental health and graduate students, mental health of PIs.

And these infographics were really striking because they were a really good way to capture some of the issues and the talk that I was starting at my institution at UNC Chapel Hill. So I reached out to Zoe, just randomly. I said, hey, you don't know me, but I'm a student at UNC Chapel Hill and could I borrow one of your infographics for a talk that I wanted to have with our department chair?

And she said yes, just make sure that you just credit me. Just put my little name on it and that's fine, and so I did, which then spurred a whole bunch of discussions within my department, and at which point I went back to Zoe and asked her if she had other infographics. She did. It blossomed into this really beautiful relationship between us and the opportunity came to perhaps write a paper together based on some of her expertise, and some of what I experienced, and that's how we came together.

I don't know, did I capture that OK, Zoe?

Zoe Ayres: Oh gosh, yeah.

Juanita Limas: I'm sure I missed something.

Zoe Ayres: The kind of amazing thing about social media and just connecting people and-- I think we just hit it off straight away, didn't we, Juanita?

Juanita Limas: Yeah.

Zoe Ayres: And we understood that we were experiencing similar but different things and it was one of those things where it was just right. We're going to be friends first and colleague second. And so when this opportunity to write this paper came up, I think we were just like, yes, we're doing this, so yeah.

Juanita Limas: Yeah, it was an obvious. It was just very organic, but yet it just kind of blossomed into this really nice collaboration and we involved some other people as well. So the paper was just was a collaborative effort among the five of us. Look!

Oby Ukadike: Look at social media, working the way we hope.

Juanita Limas: Yeah.

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This course is open to those both in and outside of Harvard University. To learn more and register, click the link in the episode description. Registration ends January 4, 2023. Thank you and enjoy the rest of today's episode.

You published a paper titled "The impact of research culture on mental health and diversity in STEM in chemistry" at the start of 2022. Can you walk us through your findings and the four aspects of research that heavily impact mental health?

Zoe Ayres: I guess the first thing is that we really wanted to write this paper because we haven't seen any paper really doing an overarching look at STEM in general and talking about mental health, and the four areas we looked at were bullying and harassment, precarity of contracts, diversity, inclusion, and accessibility, and also the competitive landscape of academia.

Now they're not the only four things that impact mental health in academia, but they were four things that the five of us were really passionate about, and we wanted to write about. But for me, I think bullying and harassment was a really important area for us to look at. I know that so many people experience bullying and harassment in academia, and what we wanted to do with this paper was really lead with statistics, and lead with that data because so often we hear about these things and we people are trying to make change and institutions might say, well, there's not enough data.

But the data is there. And so this paper was really looking at that data and consolidating it all and saying, look, this is an issue, and here are some ways that we propose fixing those things as well.

I guess to explore the full areas a little bit further, so in terms of bullying and harassment, some of the big ones are like 74% of postdoctoral staff observed bullying behavior or abuse of power at their institution, three in four postdoctoral staff seeing that. And about half of the institutions is as part of a CACTUS survey which was a global survey of researchers showed that over half of institutions don't have a comprehensive bullying and harassment policy.

So the fact that there are huge things here that need to change that are not necessarily being addressed as one of the reasons we really wanted to explore this further with the paper.

Juanita Limas: For me the diversity, inclusion, and accessibility section was something very true and dear to me since I am considered to be underrepresented in STEM, but one of the things that I was really interested in when I was trying to write this paper is other than stating the obvious, it was really important for us to come up with a lot of statistics, and a lot of literature to show people what were some of these issues.

One of the things that I often struggled with as an underrepresented student myself, and I touched on this in the paper is that it's great to be able to get to a level where you can get your PhD in STEM. But one of the things that I was noticing is that the more degrees that I had, the fewer underrepresented minorities there were, and so it got a lot lonelier as I started to go up the pipeline.

Because of that, it became a lot more difficult and challenging to be able to see myself as an academic, to see myself as a PI because there is that sort of idea that it's easier for you to be able to see yourself doing something if you see others looking like you.

And I realized, especially in graduate school, that there were not a lot of PIs that looked like me at all. It was something that I really wanted to address.

There was another section in the paper that we talked about, which was the competitive landscape of academia. I noticed this a lot as a student myself, that you sort of set up this hyper-competition between graduate students. There's competition between PIs. There's competition between schools and departments.

I realized as I was going through school, it just it wasn't fun anymore. I started losing my passion for science. I came into academia or at least to my PhD program fully anticipating that I was going to be a PI and run my own lab. I got a HHMI Gilliam fellowship. I was Mexican-American. I was first in my family to get to high school, first to get to college. I was like, I'm going to do this. I'm going to really make a difference.

But it was my experience during my PhD that profoundly changed me. It was that coupled with the suicides of some dear friends of mine that happened during my PhD that really spurred me to think about why some of these issues were coming up and to look to Zoe to see if I could find an ally and somebody else to not only talk about this but come up with some real solutions.

Oby Ukadike: Wow. This is incredible work to even be able to talk about, and then even you both talking about your lived experience, and I'm wondering if there's any more you have to unpack in this space. What do you want from the paper and where do you want it to go beyond this for you as individuals? And even as you think about this work that you've been doing, the experiences that you've had, the colleagues that have also experienced this. What do you see in that space?

Zoe Ayres: I think for me when I'm doing mental health work, it's always about reaching just one person. And if one person feels less alone by reading this paper and recognizing themselves in what we're talking about, then that's a win for me.

And we never truly know the impact of the work that we do, but we have had some fantastic feedback around this. We've seen people doing journal clubs based on this paper, so actually going into their research environments and boldly being like, no, we're not going to talk about science today we're going to talk about this and how mental health really ties in with science and things like that. So the impact has been really important to me.

Juanita Limas: I completely agree. I would also further that and push a little bit. In fact, I've had these conversations here at my company when I first started. In fact, within the first month and a half, some of the senior VPs had gotten wind that I published this paper at the end of my PhD and they used it as bought it for a journal club here in industry for senior level VPs to talk about, and they were talking about this paper just got published, et cetera, and they and they used it as some talking points. But I would also like to see if in an ideal world, you always talk about this idea of mental health being destigmatized.

I would like the conversation daily conversations to be centered around, for example, if you have to go to see a therapist, if we have to leave early for example, somebody has to leave early from work and they go to the dentist, they say, hey, I'm leaving work early, I need to go to my dentist, I would like to see it normalize and say, hey, I'm leaving early I need to go talk to my therapist and that be OK.

But we're currently now in a situation where we don't do that. And I know many people, they leave early but they don't talk about where they're going. Not that I need to know where you're going, but I would like it to be normalized, as, I'm going to get my car checked, I'm going to get my hair done. I'm going to go talk to my therapist today. It's my weekly therapy appointment.

We're not there yet, and that's where I would really like to push us as a society to get there. It's hard and I fully admit it's hard. There's a lot of cultural aspects that are different. Different cultures think very differently about mental health. But the more we talk about it, the more it becomes normalized, and I'm glad we're at least here having this podcast and talking about this paper.

Zoe Ayres: The thing that excites me is that we're still in STEM, right? We're still doing stuff where we're starting to lead teams and lead people. And so we can be that change as well. I think publicly publishing something like this and being like this is where we're going to hang our hat, and this is where we're going to talk about these things, the more confidence it's also given me to be like, yes, I am going to a therapy appointment at 3:00 PM on a Friday. And so like, it is that sort of thing where it's like no, no I'm looking after me and that's OK.

Oby Ukadike: That's fantastic. I really appreciate you even saying the part about now you're leading teams, leading the change about changing the way your companies maybe operate or how they've done work before.

So you both started out in academia and then you transitioned to industry. So what culture differences have you noticed in respect to mental health in these two spaces?

Zoe Ayres: I turned my phone off on Friday evening and I don't turn it back on until Monday, and I actually have a work phone.

Juanita Limas: Great, great. Yeah.

Zoe Ayres: Nothing major goes wrong if I don't work a weekend, and I think for me, when I was in academia-- again, I really wanted to be a professor one day and I probably will never be that now and that's something that I've had to come to terms with.

But even if I hated where I worked then I would find another job somewhere else, and I don't have that worry that perhaps I might not be able to get tenure because I've not stayed somewhere. I can just choose to do what's best for me.

Juanita Limas: I will tell you I can echo all of those sentiments, although I will be quite frank and honest in that I'm eight months out from starting my position where I'm at, and I I'm still struggling with this wanting to work on the weekend.

That being said, I've had a wake up call because when I joined this company, one of the first things my supervisor said was, it's not that you can't work on the weekend. You can physically be here and do experiments if you want to. But we don't want you to and here's why.

And they basically gave two specific reasons. Number one more importantly, it's a legal liability, right? So it's a legal liability if you're in the lab doing experiments you get into an accident, something happens, what's going to happen?

And I said, but in academia, nobody cared. In academia, it's like a badge of honor if you come in on the weekend. You're supposed to thump your chest and say, oh my gosh, I was doing tissue culture on a weekend I had-- whatever, and it's OK.

And I'm sure there's legal liabilities in academia. I know there are. But it's just, you don't talk about it. In industry, that's a huge thing. So number one, it was discouraged. But also my supervisor told me, and he's had to tell me this multiple times, and I don't know why it's not sticking.

But he's had to tell me, if you work on the weekend it's your choice. You're a grown woman. You can do that. But you are going to burn out. You cannot sustain that for very long.

And you are in an investment. We hired you to do a job for this company and with this investment, we have to at least take care of you and think about your mental health. So if you continue to work on the weekend, you are eventually going to get burned out. And we are, like I said, we're Eli Lilly. We're in the process of trying to bring medicines to market and trying to help patients.

If I'm burned out all the time, I don't do good work. And if I don't do good work it could be really bad for some of the drugs that we're trying to develop, and then that hurts patients later on.

It's this translational aspect that I'm getting in industry that I did not get in academia that makes taking care of myself more important because now I have to think about patients, whereas in academia I didn't think about patients. It was more about the novelty of what I was studying, and it was really cool what I was studying.

So that for me has been really-- I'm still struggling with that because it's not easy to turn off my brain on the weekend and not want to work, although I am getting better about it. They just keep telling me gently every week, now you're not coming in. No, I'm not coming in. I might get online, but I'm not coming in. Hopefully it'll come around.

Zoe Ayres: I, in my first industry job, was working for an American company, and so the time zones were different. And so my boss would still be working when I was meant to be at home. And so he would call my desk and I would pick up the phone like a good worker and be like, hello, it's Zoe.

And he'd be like, why are you working? It's 6:00 PM. Go home.

And I was like, what do I do? And then I realized over time it was like, no, you're doing this to yourself. Like, it's OK. Like, do something else. Your whole worth is not tied to the research. And I think that's been probably the biggest thing for me, finding my work elsewhere and realizing that my science is a huge part of me, but it's not all of me.

Oby Ukadike: That is a pretty powerful thought and statement for everyone.

Juanita Limas: Yeah, it's hard. It's hard to wrap your mind around it. For me it still is, but my science is way better now that I actually take at least a day on the weekend and just not do anything. It really is true. It's just taken a while for it to sink in, so yeah.

Zoe Ayres: I like to think that there are pockets of academia that allow this sort of thinking as well. I mean, academia should think that the brain is the most important part of us really, right? We have to look after that and so I do think there are places where there is more space to be a little bit more human, and less like a robot, I guess, or at least, I'd like to think it's changing that way.

Oby Ukadike: What are some things institutions can do to create a more accommodating and inclusive research culture?

Zoe Ayres: I could speak about this until the cows come home.

Juanita Limas: Me too. Me too. There's a whole bunch. I was like, oh boy, how much time do we have? There's a lot of things. I mean, that's the beauty of this discussion. And that's the beauty of this paper. It's that we don't pretend to solve everything, and we can't solve everything.

But we try to, at least at the very end of the paper, to give some what I call low hanging fruit examples that may or may not apply to your institution, but may give you some food for thought or spur some discussions to try to change things at your institutions, a lot of different things.

So one of the things that we did not mention in the paper that I've always wondered about, and that a paper just came out actually in June about this. The idea of reverse mentoring. You think about a typical normal mentoring situation where you have a PI, a senior scientist and then you have a junior trainee and that's considered to be mentoring.

And so the idea is that there's a flux of ideas that goes, the PI knows how to navigate the field, the PI knows who are the who's who, and the PI can tell you how to design experiments. And then you learn from that and then you grow and then you leave.

Well there's also a reverse mentoring aspect where in fact the trainee could in fact teach the PI some things as well. And this in particular, I think, resonates with a lot of students that are underrepresented. And the reason why I say this is because the majority of PIs in academia, at least in the United States, are not underrepresented. They are majority population PIs.

And so we're coming into a situation in particular where the population is changing, at least in the US, where it's becoming more and more diverse, and these students are eventually going to hopefully make it into the STEM pipeline, but we're going to see a dramatic shift in what the PhD student will look like in another 30, 40 years, right?

And so I think there's a really great opportunity for potential for this sort of reverse mentoring aspect of it. And I can think of my situation. My PI was a white woman, but I'm sure I taught her a lot of things about what it was being a first generation student, my concerns that I had in graduate school were some of them were very unique to her, things that she hadn't thought about, but things that were very real that affected how I develop as a scientist. And I would like to think that I taught her as much as she taught me.

There are some things around that institutions could start looking at and start having some dialogues about this sort of reverse mentoring. I have some other ideas. But I want to give Zoe a chance to talk.

Zoe Ayres: I think for me, one of the things that I see routinely from institutions when it comes to inclusive research culture is that people are waiting for this big punch of data that it's just going to be right, this is a problem, and this is in your face, and this is we need to fix it now, and that data is already there.

And so institutions need to be looking at this data, sometimes institutions can also hide behind generating more data. So more surveys looking into things and trying to get a grasp on their own department, but what we know is that a lot of these things are mirrored across countries, across departments, and so really, it's saying actually recognizing that some of these things are issues and actually acting on those,

And in the same sense in terms of data, often if it's a marginalized or minority group, then those data experiences may be small, so we might not have a huge amount of data saying this is difficult because we've only got a few of those individuals in positions, right?

So we can't say, oh, there's not enough data for us to act on that. We need to say, well, actually, we have data, whether it be quantitative and statistics, or qualitative accounts, we need to act now, and that's what I really want to see institutions doing and saying, right, we are going to go in and change these things because that needs to be done.

Juanita Limas: Even things like tenure have mental health discussions or have sort of initiatives that you start as PIs have it built into a tenure dossier. Even in industry, I'm thinking about eventual promotion later on and as a part of your dossier, you are encouraged to sort of be involved in volunteering in the community mental health initiative.

You're encouraged to do these things. You're not supposed to do it 100% of the time, but as part of a well rounded dossier and well-rounded package, they don't want just robots and scientists to just only think about data. We're in the business of trying to help patients. So we need to be well-rounded scientists, and so it's openly talked about, at least in industry, and I think institutions could also be thinking about things like that as well. There's a lot of different things that institutions could be doing.

Zoe Ayres: I think it all comes down to sense of belonging, right? So if anyone feels othered and doesn't feel like they are part of the academic system, that needs to change. And so addressing anything that makes people feel othered is a really, really important thing to do, and that's kind of looking at institutions from a very holistic perspective, and being, like right, OK, is it precarity of contracts? Is it bullying and harassment? Is it mental health support in general? All of those things have to come together to make things more inclusive.

Juanita Limas: We often talk about mental health as the problem of the individual, and we don't talk about mental health is the problem of the system, that the system itself has a mental health issue. We think about individual people having mental health issues. But you cannot talk about individuals unless you talk about the system itself. So what are things that we could be doing to try to change what is wrong with the system?

Sometimes people don't want to have those conversations. It makes them uncomfortable. Sometimes they don't want to admit hey, we don't have enough resources on campus. We only have two mental health counselors to deal with let's say 300 students. There is a problem. Why don't we try to do something about that? Well we don't have any money.

Well, you have money for other things. Like they always say like, you know what is a priority for somebody if you look at their budget. So you look at the budget of where people, and where these institutions-- what they're spending their money on.

They're not spending their money on mental health? Then maybe we need to have a conversation as to why that is, and talk about changing that. There's a lot of different things that we could talk about, but these are things that sometimes make people really uncomfortable.

Zoe Ayres: I think a lot of it also comes down to institutions wanting to log that they've done something rather than do something because they actually want to make change.

Juanita Limas: Check the box.

Zoe Ayres: Yeah and so again it has to be done in consultation with academics that need that support and things like that. So it's not just being done just a tick a box.

Oby Ukadike: The comment you just made about the system versus the individual, that can be translated and used in a lot of different spaces with a lot of different things. And honestly I could talk to you all for a lot longer about this topic because I think it's very interesting and mental health is incredibly important. And as we come to the close of this podcast, what advice would you give to someone who feels their institution isn't doing enough to prioritize mental health? And in concert with this question, what role do grassroot movements play in this scenario?

Zoe Ayres: So I guess to start with, if you feel that your institution isn't doing enough to prioritize mental health, I would say one of the real things that have helped me, again, kind of started off the podcast with this is social media is out there for you to be able to connect with other individuals if you are struggling, particularly if we find ourselves at an intersection.

So we might be intersect several different marginalized characteristics, the less likely we are to find people like us at our institutions. So social media really helps with that. So yeah, first of all finding your community and connecting with those individuals because they might have done some of the work for you So? That you can then translate and use that in your own institution. I'm a big fan of not reinventing the wheel if that information is there.

The other thing is that the only real way that we drive change is by grassroots movements because we have to say look, this is an issue and we need to speak up about these things. Now we can't make change without senior individuals kind of feeding into that. So it has to be a team effort between grassroots efforts and senior management. But it is, again, just saying this is an issue, and we need to talk about it, but also I want to caveat that with mental health is a particularly difficult topic to talk about and to discuss in environments, and you don't need to drive the change if you don't feel comfortable driving that change.

I think there will always be other people driving that change. And I think the most important thing with mental health is protecting your own mental health. And if you're in a good space, then you can actually help others.

Juanita Limas: Yeah. When you said that last part, that reminded me of the put on your oxygen mask first. So what, you're going down in a plane and the plane is crashing, what do you do? You put on your oxygen mask first, even before your own child. You put your oxygen mask on first before you can help everybody else. That is incredibly important.

And I will say that this resonates with me personally, because this is how I actually got dialogue started at my institution. We were not talking about mental health in my department at all. We were just going along with our great department. Students were plugging along in their labs, but if you talk to students individually, we all were just going through a lot, some environments more toxic than others.

And it wasn't until unfortunately one of my dear friends took her life that it really spurred me to-- I wrote a letter. I was a part of HHMI, a Gilliam Fellow, and I wrote a letter to HHMI, and I got other Gilliam Fellows to help me write this letter to try to start talking about mental health among underrepresented minority students getting PhDs in STEM, and it was those discussions where I found allies, other students that were also struggling throughout the country.

We wrote a letter to HHMI where we had a year long conversations that then spurred all kinds of changes within the HHMI Gilliam Application process. So now it's built in that you are required to go and think about what are the mental health resources that you have at your institution? It's built into the application as well that the PIs also have to write a statement about it.

There were a whole bunch of other changes that we got which then also spurred me to have conversations at my own home institution. Unfortunately, like Zoe was saying, it does take a lot of grassroots actions. Sometimes that falls on the population groups that really don't need to be taxed anymore. I can tell you just, there were times in grad school I got tired of having to start this, and start that, and start this. And I'm like, I'm trying to get my PhD. But at the same time I'm like, if I don't start it, nobody's going to start it and this is a problem.

But it's really nice to be able to see of things blossom and things kind of grow organically. So there is value in these sort of grassroots movements, but like Zoe was saying also it's incredibly important to get buy-in from key allies as well. It's not enough just to be able to just talk about these issues. You need to have buy-in from your department chair, or from a dean, somebody. You need to have somebody's ear that is on your side that at least understands and can kind of move the ball forward for you, open doors, or be a sponsor, if you will. That's incredibly important.

Oby Ukadike: Thank you both. It has been such a pleasure having this conversation with both of you, and honestly we look forward to hearing more about the work that you're doing in this space, and having you back. So thank you.

Juanita Limas: Great. Thanks.

Zoe Ayres: Thanks for having us.

Oby Ukadike: Thank you for listening. If you enjoyed this episode, please rate us on iTunes and help us spread the word about the amazing research taking place across the Harvard community and beyond. We are always looking to connect and collaborate with the research community, and would like to hear from you. Please feel free to email us at onlineeducation.catalyst.harvard.edu to inquire about being a guest on the podcast.

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