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Assisting the Distressed Trainee

As a supervisor or training director, you are responsible for the productivity and well-being of your trainees. One of the hardest parts of supervision is providing guidance when there is evidence of mental health or substance use issues that are affecting your trainee's performance or relationships with other team members. These issues can create stress not only for the trainee, but for the supervisor and other staff as well, and they can adversely impact the productivity and morale of the larger work unit. Supervisors facing a trainee with behavioral health or substance use issues may feel unprepared or lack the knowledge of the procedures needed to manage these situations. This can lead to feelings of discomfort, avoidance and a range of personal reactions. Navigating the joint responsibilities of getting help for the trainee and directing their professional trajectory can be challenging.

For example, you may notice changes in a trainee's behavior on the job. These may be subtle, such as a trainee who does not "seem himself" or looks unkempt. Or there may be more overt signs of a problem such as a marked decline in performance, irregular attendance, or inappropriate behavior. These symptoms can be signs of a transient stressor or an underlying mental health condition. Your observations and guidance can help a trainee access resources that can improve their personal and work-related performance.

We want trainees to seek and receive assistance before concerning behaviors escalate. While it is not your role to make a health assessment of the trainee, it is important to "trust your gut" in these situations and to take action. You can play an instrumental role in your trainees' success by directing them to appropriate resources, thus reducing the risk of potentially serious consequences. Your reassuring words, expression of concern, and engagement of appropriate resources can make a significant difference in the life of a trainee and the larger NIH community.

Ideally, if a trainee's need for additional support is recognized early, a timely referral to the relevant resources can help prevent further escalation. More complex situations may require multiple professionals to act in concert to inform clinical and administrative interventions.

The materials listed below were developed by the Trans-NIH Distressed Trainee Working Group, which included representation from NIMH, the Occupational Medical Services, the EAP, the Office of the Ombudsman, CIVIL, the Training Directors Committee, and the OITE. They will help you to better observe and recognize concerning symptoms that may indicate trainee distress. They will also help you identify referral resources available to you and the trainee. The goal of the information presented here is to help you manage emergency situations and to prevent less acute behavioral problems from escalating.

Supervisor's Toolkit for Assisting the Distressed Trainee

  • A Comprehensive Guide for NIH Staff: Recognizing the Distressed Trainee (This document is currently being converted to Section 508-compliant format; for a non-compliant copy of the document, contact the OITE.)
  • Flyer: Resources to Support the Supervisor and Distressed Trainee
  • Bookmark: Resources to Support the Distressed Trainee
  • Bookmark: Quick Tips to Help the Supervisor Recognize the Distressed Trainee
  • Wallet Card: Resources to Support Trainees and Supervisors
  • Slide Deck for Supervisors: The NIH Distressed Trainee Project

Resources to Support a Distressed Trainee


The OITE: 301-496-2427

The Employee Assistance Program (EAP): 301-496-3164

CIVIL: 301-402-4845

Office of the Ombudsman: 301-594-7231

Occupational Medical Service (OMS): 301-496-4411

NIH Police: 911 from a campus phone; 9-911 from a non-campus phone; 301-496-5685 (non-emergency)