Take It or Leave It: Does a medical leave of absence help or harm?

“I can’t go back to Georgetown, there’s no way I can come back the way I am.”

When Georgetown students arrive on campus, they have their road map to success planned out: earn top grades, join every club, make best friends, and, above all else, graduate in four years.

Katie DuBois (COL ‘15) had a plan. She was working her way to law school, all the while enjoying her college experience. Before her junior year, however, an eating disorder caused her to take a medical leave of absence—approved time off from Georgetown to cope with physical or mental illness.

Senior Associate Dean Anne Sullivan stresses that students can request to take a MLOA any time during the semester with the endorsement of Counseling and Psychiatric Services. “Basically, the premise of the medical leave is that there are health issues at play that have complicated the student’s ability to function as a student,” she said.

Director of CAPS Philip Meilman, Ph.D., estimates that CAPS will see roughly 25 percent of the total undergraduate population by the time of graduation. This being the case, it’s no surprise that Dean Sullivan noted that out of the 400 students she personally advises, she has seen four or five take a MLOA this term alone.

In recent years, the university has seen an increase in MLOAs, according to Associate Dean Sue Lorenson. “I think we see more leaves and I think that it’s because … we have a more diverse student body in terms of mental health issues than we used to,” she said. “Recognition of mental health issues is more sophisticated than it used to be which means that students who might not have felt comfortable being far from home or might have been concerned about their ability to succeed academically are doing fantastically well in competitive academic environments.”

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DuBois started getting treatment for an eating disorder during her sophomore year, but as time passed, it became too much to bear. “I was seeing someone in CAPS for an entire year, and the feedback I was getting was, ‘Well, your weight is not at a dangerous level, so it’s fine,’ … And for me, I was falling into pieces,” she said. “I wanted them to take it more seriously because sure, maybe I’m not at a dangerous weight level, but clearly my state of mind is not great. I guess that attitude encouraged me to keep pushing through.”

Just four weeks before the 2013 fall semester, the start of her junior year, DuBois realized that she could not return to Georgetown. “It’s hard, because you see it as a failure, or at least I did. And you don’t want to admit that you can’t handle it,” she said. “ I almost just felt like I was just giving up because I didn’t have my counselors at Georgetown saying, ‘Okay, this is what’s best for you.’ There really was no guidance. … I wanted to feel like [the university] was more involved in my future, like they had a stake in my outcome.”

Dean Lorenson explained why an academic dean may not think to advise a student to take a leave of absence. “There is an intersection between a student’s individual academic issues and a student’s health or mental health issues,” she said. “That intersection is so important, so that’s why you might not get a strong recommendation from a dean who’s primarily seeing the academic part.”

DuBois may have slipped through the cracks of the system for so long because, while her eating disorder weakened her, her academics remained strong. This is not the case for all students who take MLOAs.

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Ben Saunders (SFS ‘15) had the MLOA paper ready to sign. Ultimately, however, he decided to cope with his major depressive disorder and general anxiety disorder on campus, a decision he said was motivated by his own ambitious nature.

“We’re a top-tier college—accepting weakness isn’t something we do very often,” Saunders said.

For Director of the Academic Resource Center Jane Holahan, Saunders’ mentality is a growing trend among American students. “I’ve seen this growth in anxiety over the past 16 years [I’ve been here],” she said. “It starts in the earlier grades, and I think it’s learning those skills of how to cope with stress when things don’t go as they should go.”

As his third year at Georgetown began, Saunders’ acute depression took hold of his life. He couldn’t hold a conversation with friends. He couldn’t focus in class, much less learn the material. Eventually, he couldn’t ignore it any longer. He had to visit CAPS.

“We like to think we have agency over basically everything in our lives, and accepting I had depression was kind of a surrendering of agency,” he said.

For Saunders, his decision to work through his depression on campus has been positive, but not without difficulties. “Staying on campus, you’re going to have to be prepared for operating as best as you can, and knowing that as best as you can might not be what you’re used to,” he said. “I was slower with my writing process, I was slower with studying, and that got better with medication and having someone keep tabs on me.”

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Unlike DuBois or Saunders, Michael Raleigh, who entered the College with the class of 2015, felt as if he didn’t have a say in his story. He claims he left campus primarily because CAPS coerced him. Now, after a year away from Georgetown and merely a few months back, he is again feeling pressure to take yet another MLOA.

“Right now I’m part-time, but I’m struggling once again with CAPS wanting me to take medical leave. I’m in that process right now again,” Raleigh said. For him, another MLOA is unrealistic, as it would be financially difficult to be off of his scholarship, which helps pay for his campus housing.

“Even though I’m not doing as well in classes, I’m still passing. I’m not going to come out with a stellar GPA, but that’s so inconsequential to me—I just want to graduate. [University officials] seem to want me to make straight As and do a wonderful job,” Raleigh said.

Academic concerns aside, Raleigh feels as if it is personally an undesirable option. “I feel a disconnect with some of the bureaucracy as far as CAPS realizing that. If I do get medical leave, I’ll have to take time off and get more depressed,” he said. “At this point, right now they’re telling me that I have to take a year off or a semester off again—it’s just like a spiral effect.”

Meilman insists, however, that MLOAs are always voluntary—at least on CAPS’ end. “For both exits and returns, CAPS will make recommendations to the dean’s office based on the information it receives, although it is the dean’s office that makes the final decisions,” he wrote in an email to the Voice.

Dean Lorenson said the “only time the university can impose an involuntary medical leave of absence is when the student is a danger to his or her self or the community. In my 17 years at Georgetown, I think I’ve maybe seen that once. [It’s] extremely rare.” Instead, she explained, a more common occurrence is when a struggling student is at risk for an academic sanction, such as suspension if a student fails multiple classes, in which case the dean’s office may suggest medical leave in lieu of failing. She notes, however, that even this option is voluntary.

“We don’t say it to the student, but when you’re in mental health trouble, your ability to see reality, to perceive reality, understand, [and] sort out sensible courses of action can be impaired and so it may feel like coercion,” Sullivan added.

In fact, forcing students to take a MLOA is illegal. In 2011, parents of a disabled student filed a complaint against Georgetown with the the U.S. Department of Education’s Office of Civil Rights. They alleged that the university “discriminated against the student based on her disability when it subjected her to certain conditions as a requirement for re-enrollment following a medical leave of absence.” As a result, the Voluntary MLOA Policy, at least in writing, underwent critical changes, reflected in an updated version in effect May 2012.

“I think the biggest difference—the outcome of the change in policy—has been that there is more individualized care,” explained Dean Lorenson. “There used to be a one-size fits all prescribed timeline for a medical leave, at the minimum, and now there is not. That’s determined on a case-by-case basis in consultation with the student, the student’s caregivers, and CAPS.”

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“I was really terrified about what would happen, hearing statistics about people who take off and never come back, and wondering if that’s going to be you.”

Fortunately, DuBois made it back to the Hilltop. According to Director of Student Health Education Services Carol Day, most students do. “It’s a very rare situation when a student isn’t able to return,” she said. “The university really feels that this is a great opportunity for students to get the support and help that they need and then come back. The process itself is supportive and hopefully well-designed to give students a break when they need it.”

Some students disagree that the process is quite as accommodating. DuBois only wanted to be away for a semester, as she was determined to graduate on time with her friends. This meant that in order meet the re-entry deadline requirements for the spring semester, she had to write a personal essay in October convincing the university that she was ready to return—just two months after an August evaluation cleared her to take a MLOA in the first place.

“At the time I had to explain to [my therapists], ‘Look I know right now I’m not at a place to go back, I’m asking you to please write this letter so that I can go back in January. They’d say to me, ‘Okay I’m writing this letter, but if you’re not ready by January, I’m going to send another letter down there telling them not to take you,’” said DuBois, who was left feeling as if a time limit were being placed on a full recovery.

Though happy to be allowed to return to campus, DuBois was rudely awakened by the lack of support upon her return, and frustrated by the barriers she has faced. “Since coming back, there’s been zero follow-up. They have no idea what I’m doing—the university has no clue. And that’s really frustrating to me right now,” she said.

Now that she has taken a semester off, she is not allowed to see a therapist or psychiatrist through CAPS—a rule that she wasn’t made aware of. “I have to go outside the community, which I was not aware until about a month ago when I called my counselor because I was having a mental breakdown.”

DuBois saw a therapist in Woodley Park over the summer for $140 per session, but had to stop because of expense and travel issues. CAPS, however, did give her plenty of referrals. “There are individuals in CAPS who really do care, but it’s way more hands-off than I was expecting.”

“I guess maybe they think they’re not equipped to handle someone [like me]. Nobody told me that, nobody told my parents that,” she said.

Part of coming back meant that DuBois had to have a personal treatment plan for her long-term recovery in place. However, DuBois’s plan involved Skyping her therapist which was not a realistic alternative to in-person counseling. She went from multiple therapy sessions per week to radio silence.

“I always think people with mental health issues are always quick to pass the blame off from themselves,” she said. “So it’s quick to say, ‘Oh, they’re not helping me.’ But we’re a damaged group of people—and I don’t mean that in a sense that we’re not able to function, just in the sense that when we hit our lows, we hit our lows. And it’s nearly impossible for someone at their lowest point to pull themselves up and say, ‘I’m going to get help.’ You need that support system there.”

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DuBois didn’t want to deviate from her plan. But even after making charts of how many credits she’d need and mapping out the logistics of graduating on time, she realized in her decision process that those important factors paled in comparison to her well-being. She looked great on her transcript, but she wasn’t happy.

“When it comes down to it, if you can’t be here, you can’t be here. You can push through, you can get a 4.0, you can do all the internships in the world, but nothing that you do now is going to matter if a year from now you’re just not functioning because you didn’t take the time to take care of yourself.”

For Raleigh, his pressures are less personal and more institutional. “I just feel like there are higher-ups looking down upon us and saying this person is mentally ill, therefore he needs to be away from the community … I’m trying the best I can given the limitations I have. I feel like they’re not understanding that it’s just part of who I am.”

In his encounters with other students in similar situations, the consensus has been that barriers—whether within CAPS, financial aid, or housing—have hindered the process of moving on. He has even considered transferring at the recommendation of his dean. “I don’t really like the way Georgetown presents this perfect image of this individual who has to act a certain way … There isn’t enough open dialogue on campus.”

Saunders may have stayed on campus, but that doesn’t mean his experiences with depression and anxiety disappeared—he started a Georgetown branch of Active Minds, which advocates for awareness of mental health to help facilitate such dialogue on campus—nor does it mean he would suggest the same path to someone else.

“Anything that deviates from our typical plan of success is not something that gets entertained much,” he said. “Look at things in the bigger picture: if it’s one more year of college that you have to have in order to be healthy and have a positive experience here, then it’s worth it.”

Saunders is working with the Georgetown University Student Association to improve CAPS, the MLOA process, and perhaps even add a new case manager, which he believes could make a huge impact in the well-being of returning students. Currently, Katie Boin is the sole case manager at Georgetown.

Day thinks the timeline can be an issue for students, but is also particularly concerned with registration. “If you are off, you are not eligible to preregister for classes in the usual way, you have to wait until everyone else is done and find whatever classes you can. I think that is something we should attempt to change,” she said.

Dean Lorenson notes that students on leave don’t necessarily need to wait to register just because they are not active students—deans will work with them to get into classes. However, for many students, classes aren’t, or can’t be, their primary concern.

Housing troubles add an additional layer of stress that can be fixed. Day believes more support targeting the group of returning students each semester would be beneficial. “A liaison to a student on leave would be good because we are also dealing with in real time students who are struggling who are here on this campus.”

DuBois also stresses the need for stronger support once students return. “There needs to be stronger follow up, 100 percent. I don’t exaggerate when I say I had no contact with CAPS until this past summer, and I had been back since January,” she said. “There should be some type of follow up, where your old counselor reaches out every month, every other month, just to make sure everything’s going well—because it’s easy for us to slip through the cracks.”

[Editor’s note: A previous version of this article incorrectly attributed a quote from Dean Sullivan to Dean Lorenson. It has since been corrected. Also, an instance of the term “preregister” has been corrected to “register.”]