Yale MH Settlement Reflection of Nationwide Issues

Teetering on the boundary between adolescence and adulthood, college students are very often left out of the public discourse around mental health, said Jessi Gold, M.D. “They’re not quite kids and they’re not quite adults—we call it the transitional age,” Gold said. “Because of that, they don’t always get seen, their problems don’t get amplified, and when they do [become a topic in the] public discourse, a lot of people think they’re just complaining.”

Gold is a member of APA’s Council on Communications and an assistant professor in the Department of Psychiatry at the Washington University School of Medicine in St. Louis. She specializes in college mental health, and she believes it is vital to examine how policies at the systems-level, including policies held by colleges, impact mental health.

“These policies that we put into place thinking they’re the best policies are often made without mental health in mind,” she said. “What might seem best for a school or another system may not be best for a person, and then people struggle.”

At Yale University, students and alumni have alleged the Ivy League school’s policies were discriminatory toward students with mental illness, forcing them to leave school. In 2022, a lawsuit was filed against the school by students and Elis for Rachael, an advocacy group that was created after the death by suicide of a Yale student. In August, the lawsuit resulted in a settlement that makes numerous important policy improvements at the school, said Monica Porter Gilbert, J.D., policy and advocacy attorney at the Bazelon Center for Mental Health Law, one of the law firms that represented the plaintiffs.

Prior to the settlement, the lawsuit alleged, students were forced to withdraw from school when facing mental health challenges. They were then faced with what the lawsuit called “a daunting reinstatement process,” submitting many of the same materials that were required when students initially applied to the school.

Under the settlement, Yale now offers part-time study as a reasonable accommodation for students who have urgent medical needs. Additionally, Yale students on medical leave (which the school previously referred to as medical withdrawal) will now be able to retain access to campus spaces and resources, including remaining on Yale’s health insurance plan for up to a year.

Further, procedures that students must follow to access medical leave, as well as reinstatement, have been streamlined and clarified. Lengths of leave under the settlement are individualized, and Yale is committed to strongly considering the student’s treatment team’s opinion in deciding when students can resume their studies.

The settlement also outlines the procedure when, “in rare circumstances,” a student is required to take a medical leave of absence on an involuntary basis. This may occur if there is a significant risk to the student’s health or safety, or the health or safety of others. In these cases, the student is individually assessed, during which input from the student and the student’s treating clinician are taken into consideration. If the school decides to put the student on an involuntary medical leave of absence, the student has seven days to appeal the decision.

“Students who have experienced Yale’s policies prior to the settlement have told us that the policies this settlement puts in place would have made a real difference for them,” Gilbert said.

Following the settlement’s announcement, Yale’s Dean, Pericles Lewis, Ph.D., said he was pleased with the outcome. “Students and alumni have shared constructive ideas with Yale administrators and clinicians, and my hope is that the changes that have emerged from these discussions will make it easier for students to ask for support, focus on their health and well-being, and take time off if they wish, knowing that they can resume their studies when they are ready,” he said in a statement.

An Example of Widespread Problems

Gilbert said that the Yale case was an example of a lot of issues that exist at colleges and universities nationwide. “In terms of reasonable accommodations, there remain a lot of universities, as well as students and faculty, who do not know that students with mental health disabilities such as anxiety, depression, or posttraumatic stress disorder have federally protected civil rights and are entitled to reasonable accommodations,” she said.

College is a unique environment, said Meera Menon, M.D., an assistant professor of psychiatry and behavioral health at The Ohio State University’s Wexner Medical Center. Every single aspect of students’ lives is wrapped up in the school, such as their health care clinicians, social lives, and academics. “It’s a mini city,” she said. “For many students, leaves of absence can be necessary, but they come with their own challenges.”

Even the decision to take a leave of absence can be burdensome to some students. Leaving school means leaving their friends, possibly their doctor, and perhaps even losing their health insurance, Menon pointed out. “That’s why it can be so helpful for the colleges and universities to give the students options so they have to take a leave of absence only if it’s really necessary,” Menon said.

Some colleges help students collaborate with their instructors to allow flexibility on courses, attendance, and deadlines so the students can participate in intensive outpatient or partial hospitalization treatments, Menon said. Supporting students’ ability to pursue these different mental health treatments is key, she continued, because it may help prevent a leave of absence from becoming the student’s only option.

Changes Can Be Made at Local, State, or Federal Level

Over the years, Gilbert said she has seen improvements. Some schools have instituted policies that allow students to continue studying or accessing college resources while managing their mental illness without litigation from students or advocacy groups prompting the change. “But there is still a lot to overcome,” Gilbert said.

Policies at the federal or state levels could make a big difference for students. In September, Sens. Edward Markey (D-Mass.), Elizabeth Warren (D-Mass.), and John Fetterman (D-Pa.) wrote to the departments of Education and Justice, emphasizing the need to issue guidance to colleges and universities on their policies regarding voluntary medical leaves of absence.

“Lack of awareness of … policies, administrative barriers, social isolation, financial and immigration hurdles, and fear of retaliation create real and significant barriers for students who need support,” the senators wrote. “They should not have to choose between their health and education.” ■