I was a college president when I routinely began having trouble sleeping, a problem I had never had before. It started after a difficult few years: Both of my parents had recently died, I was traveling a lot and exercising very little, I had moved away from my closest friends to take the position, and my family life with a commuting spouse and two young children had never been more hectic. One night, I had finally managed to get to sleep when I awakened with what I immediately recognized as a panic attack: Heart racing, sweating, I felt an awful mix of agitation and impending doom.
As a medical doctor, I knew what was happening but couldn’t get myself past it. Fortunately, my husband, a psychiatrist, helped me through that moment, and my primary-care doctor quickly linked me with appropriate care and treatment. It hasn’t happened since. But I believe the panic attack was directly related to the increasing stress of the presidency, which felt quite different from the stress of previous leadership positions I had held.
Being a college president was all-consuming, 24/7, and more personal in many ways than my other administrative appointments. For better or worse, I was “the college” in the eyes of many.
Likely, more than a few senior administrators will read about my “panic attack while leading” with a sense of recognition. Mental-health conditions remain extremely stigmatized in the management ranks, and current presidents might question if it is wise to even raise the subject while you’re still in office.
Only a few college leaders have spoken openly about their mental health, and almost none have revealed serious mental-health problems on the job. Yet with the uptick in students, professors, and staff members reporting burnout, stress, and anxiety since the pandemic, it’s reasonable to assume that top administrators are also experiencing those same complications in their mental well-being.
For presidents, establishing a support system and getting mental-health support raise different and difficult issues. In its 2023 survey of college presidents, the American Council on Education found that only 10.8 percent of presidents disagreed or somewhat disagreed with the statement, “I have a support system with whom I share my feelings and stressors.” But 68 percent of presidents agreed or somewhat agreed that “I struggle to find people who understand the experience of being a president/CEO.”
Why?
For most people, local friends and mental-health professionals are logical choices to turn to for support. But it’s complex for presidents and senior leaders, especially in college towns, to make friends locally when you run the town’s largest employer. It can also be hard to find a therapist when the area’s mental-health resources are limited and you are likely to interact socially or professionally with any local providers.
Online counseling services are more readily available nowadays and have expanded the options for leaders to access mental-health care with some assurance of privacy. But taking that step in a high-profile position may still feel professionally risky and uncomfortable for many.
The job of running educational institutions has never been more difficult or taxing. And things may only get worse in the months ahead with multiple wars sparking protests on campuses and with a looming presidential election that may once again place the education sector in the crosshairs. These political concerns are on top of other serious threats to higher-education institutions, including declining enrollment, increasing costs, decreasing state allocations, DEI backlashes, and debates about the value of higher education, to name just a few. Such factors are sure to raise the anxiety and stress facing many leaders, which in turn could lead to (or worsen) their mental-health or medical conditions.
Now is the time for governing boards and institutions to prepare for the coming volatile years and support their presidents — as leaders and as human beings. Below are my suggestions for how best to help top administrators and their institutions to succeed in difficult times.
Recommendations for Senior Leaders
Guard your health. Of course, as a medical doctor, I must emphasize the importance of the basics associated with optimal mental and physical health: adequate sleep, regular exercise, and a healthy diet. All three can be hard to maintain as a president, based on the long hours. Outside of the workday, you’re expected to attend a lot of social engagements and fund-raising events that include not-very-healthy meals.
Guard your friendships. Social support also greatly affects mental health. Set aside time to do a careful scan of your social-support network: spouse and family, friends and colleagues, religious communities, social groups such as athletic teams and book clubs. Each person’s ideal network will be different, so come up with a plan to strengthen the connections that are important to you.
Consider finding a career coach and a therapist. Try to do that before you reach a point of high stress. For many leaders, it might be best to onboard your support team even as you onboard in your new position.
Coaches and therapists play different roles, but their support can be complementary. A career coach can help you focus on work-related interactions such as how to build support for a particular institutional strategic direction or how to interact with your board. A therapist will focus more on personal psychological issues such as how to deal with constant negative criticism or how to minimize rumination on issues or problems that are keeping you up at night.
Develop your own stress-relief toolkit. What works for you might be playing music, training for a marathon, or volunteering. I never thought of myself as the meditating type, but I have found mindfulness-based stress-reduction techniques to be helpful, and evidence of their effectiveness is strong.
If possible, also consider having a place to escape your “home.” Especially if you live in an official residence on the campus, line up another place off campus where you are not defined by your institutional position. Insist on making room on your calendar to stay there. It may be a second home or a small apartment. It could be regular visits to relatives or friends, or even camping trips. Go anywhere that allows you privacy, and room to breathe and let your guard down.
Get help if you need it. If you think you might have a mental-health condition that needs treatment, do not hesitate to seek help. If you are concerned that disclosure of a mental-health diagnosis might harm your career, you have options for minimizing that risk. Talk to your primary-care physician. Remember: Your health is actually more important than your job.
Recommendations for Trustees
Plan for the president’s eventual need for rest, review, and renewal. The best time to do that is during the hiring negotiations. I would encourage boards — at the time of hire — to set a timeline and an expectation for the president to take vacations or sabbaticals. This approach normalizes rest and saves the president from having to ask for time off, especially for stress-related mental-health problems.
Enough with anonymous 360-type reviews. I would encourage boards to move away from or modify the protocols for extensive job-performance surveys and interviews that go beyond direct reports. The personal vitriol now commonly seen in even the strongest and most positive compilations of such anonymous reviews may have sizable effects on a president’s mental health and can be toxic to their leadership in ways the board may not even know. For example, the president may have an anxiety disorder or be dealing with depression.
Trustees should weigh the potential benefit of this information against the potential harm. One option: Add an intermediary to the process who could synthesize or summarize the constructive and critical feedback.
Talk about mental-health benefits. The start of a leader’s tenure is also the right time for boards to ask some quick questions about their institution’s administrative handling of health benefits. Federal law prohibits disclosure of confidential information about any mental-health or other medical treatments or services or conditions without consent.
But many leaders do not know the details of how their institution handles their medical-billing information. A board should confirm how the college deals with this kind of sensitive billing, and make sure the president understands the process. Confidence in their privacy might encourage leaders to take full advantage of their benefits, including mental-health support.
I am sharing my personal experience and suggestions for making a tough job better because I feel comfortable doing so in order to increase awareness of this important and rarely discussed issue. Every institution should be concerned about the mental health of all of its employees, including its leaders.
Of course, some will say that the stressors and mental-health risks leaders face are just “the price of the ticket” — for their salaries, prestige, and the power inherent to these positions. But the average tenure for a president has decreased, and a significant number of sitting presidents are looking for the exit. If we don’t support the mental health of our leaders, then we must not be surprised when even more presidents decide that leadership positions in the field to which they have dedicated their careers are no longer worth that price.
