Graduate students may seek mental health services for any number of reasons — for all the reasons that anyone else would seek help. But the demands of a PhD program can exacerbate existing problems with anxiety, self-image, procrastination, substance abuse, and anything else one might bring to the table.

That PhD programs generally coincide with pivotal years in one’s life, years in which lasting relationships are formed and “real life” is at hand, means that issues of balance and time management become more crucial. And the sheer fact of a typical PhD program’s long lifespan increases the likelihood that many students will feel they need help somewhere along the way.

“One of the things that distinguishes PhD programs is the unending nature of the work,” says Dr. Paul Barreira, who is the director of Behavioral Health and Academic Counseling (BHAC) at Harvard, overseeing offices including Mental Health Services and the Bureau of Study Counsel. “Law students are out in three years, most HBS students are out in two. Other Harvard schools have a built-in time limit. GSAS doesn’t.” Many students manage to sustain productivity and focus, but as responsibilities shift from class work to teaching to the relatively unstructured and potentially lonely years of research and writing, some struggle is inevitable.

When difficulties mount to the point where one’s work, daily habits, and interactions with others are all compromised, it’s time to get help. But students may hesitate for a variety of reasons: They may fear that word will get back to their advisors; they may think that their problem is insignificant and that they should know how to handle it; they may think that their problem is so complex it has no solution; or they may come from a culture or country where seeking psychological treatment is stigmatized.

“One of the biggest mistakes students make is waiting too long before seeking help, which is often due to thinking the problem is either too big or too small,” says Ellen Fox, the GSAS director of student services, who provides front-line assistance to students on a variety of problems. “Help is available for every problem regardless of its size.”