Colleges Face More Pressure to Keep Students With Mental-Health Conditions Enrolled

A lawsuit filed last week against Yale University has reignited a debate about how colleges should best help students who are going through serious mental-health crises.

The complaint against Yale reflects a larger shift in which colleges are under increasing pressure — from the federal government, court rulings, advocacy groups, and students themselves — to accommodate students with mental-health conditions so they can stay enrolled while they receive treatment.

The new lawsuit centers on colleges’ withdrawal policies, which have been the subject of scrutiny by mental-health advocacy groups in recent years. The plaintiffs, two current students and a nonprofit that’s pushing for mental-health reform at the university, argue that Yale’s policies are punitive and violate the Americans with Disabilities Act by depriving students of access to an education.

The complaint recounts students’ “traumatic” experiences of being pushed out of college after disclosing symptoms of distress and facing barriers to reinstatement. (According to a joint filing on Wednesday, the lawsuit had been put on hold while the parties try to come to an agreement out of court.)

A similar lawsuit filed against Stanford University in 2018 resulted in a settlement and policy changes that were hailed as a model of student-centered, compassionate, and transparent practices. At Stanford, forced mental-health leaves are now supposed to be a last resort, and students are not barred from campus even if they do go on leave.

The Stanford and Yale lawsuits are part of a broader push in recent years to make campus mental-health policies more flexible and student-centered.

College officials say involuntary leaves are rare; most students are accommodated and stay enrolled while they’re going through mental-health treatment. But in some severe cases, administrators say it’s best for students to pause their studies until they’re ready to return to campus. Drawing that line, however, is a challenge.

Mental-health advocates say colleges often don’t get it right. Colleges should — and are legally obligated to, the lawsuit against Yale argues — provide reasonable accommodations to students with mental-health diagnoses so they can continue their education. And if withdrawal is necessary, advocates stress that the process for a student to re-enroll should not present financial and academic roadblocks.

Monica Porter, the policy and legal advocacy attorney with the Bazelon Center for Mental Health Law, which is one of the law firms involved in suing Yale, said students and their families are becoming more aware of their rights for reasonable accommodations.

Part of the shift, too, is that mental health is becoming less stigmatized, said Asia Wong, director of counseling and health services at Loyola University New Orleans. For students, instead of feeling the need to hide their mental-health conditions, there’s been a shift to “this is an illness I’m living with, and I believe that it’s within my rights to be accommodated for that,” Wong said.

Exclusion as ‘Last Resort’

There has been renewed interest from the Biden administration’s Education and Justice Departments in protecting the legal rights of students with mental-health conditions, as well as from lawmakers.

Senator Ed Markey, Democrat of Massachusetts, sent a letter to the two departments last week, encouraging federal officials to scrutinize colleges’ use of involuntary leaves and whether they violate federal law.

Federal investigations have forced several colleges to change their mental-health protocols in recent years. Recent landmark settlements include Brown University’s from August 2021, which required the university to modify its leave of absence and readmission policies. It also required the school to pay more than $600,000 in damages to students who had been denied readmission.

In 2018, Northern Michigan University had to overhaul a policy that threatened to punish students if they discussed thoughts of self harm with their peers as part of a Justice Department settlement. And in 2016, the department reached an agreement with Princeton, requiring the university to communicate the accommodations available to students before going on leave.

“Before resorting to exclusion or putting a pause on a student’s formal relationship with the university, colleges and universities need to explore all potential reasonable accommodations that might enable the student to safely remain on campus and meet the college’s academic standards without resorting to exclusion,” Porter said. “Exclusion should be a last resort and only resorted to in extremely rare cases if no reasonable accommodation can be identified.”

Victor Schwartz, a psychiatrist and the senior associate dean for wellness and student life at the City University of New York School of Medicine, spent eight years as medical director of the Jed Foundation, a suicide-prevention organization, advising colleges on how to handle students who might pose a threat to their own or others’ safety.

As the mental-health landscape has changed, Schwartz said there’s a sense among critics that colleges’ policies have not followed the larger cultural shift toward being more student-supportive, transparent, and student-friendly. But he thinks in the last 15 to 20 years, as advocacy around the issue has increased, more colleges are seeing the virtue in being as reasonably flexible as possible.

Still, “it’s a complicated balancing act,” he said.

Sometimes, it is in a student’s best interest to take a break from school, Schwartz said — especially if they can’t get access to the treatment they need on or around campus, or if they can’t keep up with their academic work. There are also rare instances where students pose a risk to the community. But there are other scenarios in which returning home would have a negative impact on a student, he said.

“Ideally, you need to be taking a holistic picture,” he said.

Finding That Balance

Wong, the counseling director at Loyola New Orleans, said the question of whether a student should take a leave of absence boils down to two key questions: Can the university reasonably accommodate the student? Or is the student better served by taking a leave of absence?

“If the second case is the case, then the university should be working to make it as easy as possible for the student to return,” Wong said.

Schwartz thinks reinstatement policies like Yale’s — which was updated in the past year but previously required coursework, an interview, and letters of recommendation — were created in good faith. Colleges want to make sure that students are in a position to succeed in terms of their health and academic functioning when they return to campus.

But when the bar is too high, rigid policies have the unintended consequences of making students hesitant to take leave, and frightened about the implications of alerting their university when they are experiencing a crisis, Schwartz said.

“When students believe it’ll be costly and hinder their academic progress to leave school, or if there will be hurdles to coming back, they might not leave when they ought to,” he said. Ideally, there should be a flexible system of tuition reimbursement or making students aware of tuition insurance, he said. Because “for many students, the loss of tuition dollars can end their higher-education opportunities.”

The recommendations made by Elis for Rachael, the nonprofit involved in the lawsuit against Yale, include eliminating roadblocks to reinstatement and allowing for the possibility of continued access to campus healthcare, facilities, and housing while a student is on leave. Schwartz said these recommendations are by and large sensible and in line with what a lot of colleges are doing.

Ben Locke, chief clinical officer at Togetherall, a peer-to-peer forum for students that’s monitored by mental-health professionals, led counseling services at Pennsylvania State University for 18 years. It’s a good thing, Locke said, that colleges are rethinking their mental-health policies to have more parity with general health leave, and eliminating some of the barriers to re-enrollment.

But he stressed that involuntary-leave policies exist for a reason. There are severe instances, he said, where keeping a student enrolled — or in student housing — poses a danger or disruption to other students and their learning.

“One of the huge challenges in reporting on and understanding these things is that due to confidentiality rules, you’re generally going to be missing the entire side of the story that holds much of the detail,” he said. “And that doesn’t mean that institutions haven’t done things wrong and should be held accountable, but it does mean we need to be really cautious about drawing very firm conclusions that institution has done X, Y or Z wrong, and we have no idea what actually happened with the student.”

He also said that calls for continuity of healthcare and housing for students on leave are contractually complicated.

“The school’s responsibility to a student who is no longer a student changes dramatically,” he said. “And I think that that really does complicate some of these requests.”

He added: “There has to be a line somewhere.”