Content warning: This article references suicide and mental health.
College students are exhausted.
Between overloading classes, working part-time jobs, and filling the few remaining hours with internships, college students are used to existing in a state of perpetual fatigue. This persistent crisis was only furthered by the COVID-19 pandemic, which disrupted the already-fragile balance students struggled to find. At universities, the spring 2020 semester was a race to the finish, with students and professors alike desperately seeking a reprieve from the catastrophe that was schooling amid a pandemic.
The 2020–2021 academic year brought its own host of uncertainty, as well as a decrease in college enrollment, at least partially due to an uptick in voluntary and medical leaves of absence. For many college students, the pandemic caused already-weak mental health infrastructures to completely unravel. Lack of social interaction, unpleasant Zoom experiences, and a general existential dread took their toll, but these were not new phenomena.
While severe mental illness is a problem across most college campuses, the issue seems to be heightened at elite institutions. This fact is particularly appalling considering many of these schools pride themselves on fostering personal and professional success while offering a multitude of resources to support students.
The solution to these fundamental problems may seem to be a leave of absence from one’s studies. For some students, a leave of absence is an opportunity to take planned time off from school—a single semester, quarter, or entire year—to pursue internships or travel. On the other hand, some students do not have the luxury of anticipated leaves. In emergency cases, students will take a leave in the middle of a term, what universities refer to as a medical leave of absence.
It would be easy to attribute a rise in leaves of absence to COVID-19, but for Attiya Khan (Dartmouth ’22), the pandemic merely heightened existing issues.
“COVID potentially exacerbated some factors and compounded them, but I don’t think COVID is the cause,” Khan said. “This is an ongoing type of crisis and the solution has been that people have stayed silent and tried to avoid, on a structural level, taking real measures to protect students and to treat this with the respect and kind of the care that it deserves as a healthcare issue.”
Unfortunately, mental health is not colloquially considered a healthcare issue, especially on college campuses. College students have long been encouraged to work through conditions of heightened stress and burnout and are used to masking the exhaustion that is seemingly universal.
At the University of Pennsylvania, students call this performance Penn Face. At Dartmouth, it’s the Dartmouth Duck Syndrome. Georgetown may not have a specific name for the phenomenon, but every Hoya knows the feeling: put up a façade of ease and calm while struggling on the inside.
“It’s this idea that everyone is like a little duck where they look calm above the water but underneath the surface, they are paddling furiously to stay afloat,” Caris White (Dartmouth ’23) said of the image.
According to White, Dartmouth students are expected to push themselves as hard as they can during the ten-week term, crash during a break, and then do it all over again. This pressure, felt across universities, has real and detrimental effects on students.
When Skylar Rearick (University of Pennsylvania ’24) was a first year at Penn, her grandmother—who helped raise her—was hospitalized and eventually passed. She found herself struggling at a university where personal and academic hardship felt like something to suppress.
“People don’t necessarily talk about the difficulties with their assignments or any personal life difficulties that may be impacting their mental health,” Rearick said.
Despite decreasing her course load for the second semester, things did not improve for Rearick.
“Throughout my life, I had a lot of unresolved mental health issues that I wasn’t really even able to start addressing until I got to Penn because of lack of access to healthcare,” she said. As a first-generation, low-income student, Rearick relies on campus health services, including Penn health insurance and mental health resources.
“I was starting to dive into taking care of these mental health issues while I was starting my second semester at Penn, so trying to deal with that and school was kind of a lot.”
Rearick ended up taking a leave the week of final exams, but despite agreeing with her medical provider that she is ready to return, the school has extended her leave until January 2022.
“In a way, I feel like I am being forced out because my psychiatrist is the professional, but at this point, even if she says that I’m okay to go back in August, my housing has already been canceled. I have to pay all sorts of fees and things for taking this leave at the last minute.”
Difficulties with housing are particularly relevant in the case of mental health-related leaves. Mental health crises are a common reason for medical leaves, a fact that is unsurprising considering the lack of regard universities have for mental health. However, students on leave are often barred from visiting campus during their absence, forcing students to return to potentially unhealthy home environments.
Bernie Yamakaitis (COL ’22) experienced these consequences first hand during both of their medical leaves. The first occurred in fall 2017, following a suicide attempt. After spending a few days in the MedStar hospital, Yamakaitis returned home to live with his parents, despite having a strained relationship with them—a situation that only worsened their mental health.
Two years later, in spring 2019, Yamakaitis once again took a medical leave of absence. Not only did the leave stretch for two semesters—longer than they had anticipated—the doctors at the Georgetown hospital outed Yamakaitis to his parents, straining their relationship even further. According to Yamakaitis, when a student faces a mental health crisis, university administrators and deans can provide a limited range of options and can pressure students to leave. In his case, Yamakaitis felt like the university presented him with no other choice.
“Georgetown’s official statement is that no one is forced on a medical leave, but they get around that by other ways,” Yamakaitis said.
Georgetown’s Student Health Services states that “students should consider requesting a medical leave of absence for situations that significantly limit their ability to function successfully or safely in their role as students,” and the medical leave of absence policy guide notes that “the goal of taking a medical leave of absence is to ensure that students return to the University with an increased opportunity for academic success and students should take the time to achieve this goal.”
“Medical leaves are voluntary, and the student must request them,” CAPS Assistant Director for Psychology Training Jenny Lloyd wrote in a statement to the Voice. “While the dean’s office or CAPS may advance an opinion about the wisdom of taking a leave, it is always up to the student to decide whether or not to request such a leave.”
At Georgetown and other elite institutions, administrators and staff seem to push leaves of absence when they determine that a student’s needs (such as combating suicidal thoughts) are more than the school can provide for. It is in the school’s best interests to control every aspect of the leave process in order to best protect themselves, which can manifest in students feeling like they have no say in whether they remain at school.
“You lose your sense of agency once you get entangled within the web of the policy, and it’s difficult to sort of get it back once it’s been given. Or taken,” Khan said.
Dartmouth’s leave of absence policies have come into the public eye due to terrible tragedy. This past May, Dartmouth experienced its fourth student death in the past academic year. Following the deaths of Beau DuBray, Connor Tiffany, and Lamees Kareem, it was announced that Elizabeth Reimer had also passed away. Shortly after the initial announcement vaguely described the circumstances of her death as “non-criminal,” it was revealed that she had died by suicide. Reimer became the third first-year student to die by suicide in the 2020-2021 academic year, alongside DuBray and Tiffany.
Prior to her death, Dartmouth placed Reimer on an involuntary medical leave, which forced her to return home. Reimer was desperate to remain on campus and complete her first year, claiming that going home would only worsen her situation. According to her family, her assistant dean had emailed her about a potential year- long setback in her academic progress. She died the same day she received the email.
Dartmouth’s callous leave of absence policies are echoed across elite universities. The Ruderman Family Foundation, a philanthropic organization focused on inclusion and equal access for students with disabilities and mental illness, authored a report evaluating the leave of absence policies of Ivy League schools. Not one school garnered a grade above D+ and the report found that each school’s policies were “ambiguous at best and discriminatory at worst.”
Prospective students dream of attending these schools, only to arrive on campus and be met with a lack of support and oftentimes, harmful cultures. This was the case for Yale student Rachael Shaw Rosenbaum, who died by suicide this past March. She was a first-year student and had been struggling to feel mentally safe since her arrival on campus.
While Shaw-Rosenbaum never formally requested a leave of absence, a social media post claiming she did garnered traction among both Yale students and residents of Anchorage, Alaska, Shaw-Rosenbaum’s hometown. Yale formally disputed the post in a statement posted to their website, claiming that the university “would never deny anyone permission to take time off to address a health concern; anyone who asks for that permission receives it.”
Though it is unclear whether Yale’s medical withdrawal policies played a role in Shaw-Rosenbaum’s death, the social media post catalyzed a larger discussion on the school’s leave of absence and withdrawal policies. In a conversation with Yale Daily News, students described the policies as “completely ridiculous” and “overly punitive, isolating, and expensive.”
A connection between punitive university policies and students’ mental health was clear in the case of Luchang Wang, a Yale student who died by suicide in 2015. In a Facebook post just hours before her death, Wang wrote:
“Dear Yale: I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted.”
Wang’s death received immense media attention, sparking a conversation about mental health on college campuses that has continued today.
While these conversations have been occurring for years, it seems that they yield few results beyond reactively retrofitting an inherently harmful system. After NYU saw six suicides in the 2003-2004 school year, they established a hotline. After two Cornell students jumped off of a campus bridge, campus police officers were stationed at the location. And at the University of Pennsylvania, fourteen student suicides between 2013 and 2019 drove the expansion of the campus counseling and psychological services, only to be followed by the suicide of program director Gregory Eells.
The fears and needs of college students have been pushed aside for decades, culminating in the tragic loss of life across several institutions this past year.
After the death of a third classmate in the past academic year, Khan wrote a scathing article in The Dartmouth entitled “For the Love of God, Do Anything,” demanding the Dartmouth administration change its medical withdrawal policy. In it, she declared that the university uses the policy in ways that actively hinder those who need help the most, such as low-income students and those experiencing mental illness.
Each of the students interviewed directly criticized their respective administrations’ treatment of mental health on campus, including the lack of follow-up from counselors and deans and impersonal and trite messages of support.
White wrote her own piece in The Dartmouth in April after her third classmate passed. In White’s perspective, she and her peers were not given the opportunity to process the complex emotions they were feeling after losing fellow community members, nor had she seen the school make any tangible attempt to grapple with the underlying conditions that led to their students’ deaths.
“When I wrote that piece, it sort of reached a tipping point on campus and I was so frustrated and fed up with what felt like canned responses by the administration to these really horrible tragedies,” she said. “I was just incredibly fed up and upset and tired of dry 400-word emails that were somehow supposed to make the campus just keep going as normal after someone died.”
According to The Dartmouth’s 2021 senior survey, support for Dean of Dartmouth College Kathryn Lively fell from 39 percent to just 9 percent in the past year. College President Phil Hanlon did not fare much better, with his support rate plummeting to 11 percent.
“There has been a huge, widening disconnect between the people in charge and the students who are like, ‘please help us, we are not doing well,’” White said.
Georgetown’s administration is certainly not immune from such criticism. Students on leaves of absence have complained about the school not checking in on them once they went on leave, and nearly all students are aware vital resources such as CAPS and Health Education have been overworked for years now. Georgetown can do more.
“I feel like Georgetown has to get a little more creative with their solutions other than just like, well, we don’t want you to be a liability,” Yamakaitis said.
There has been progress in recent years. Spurred by the pandemic and student-led pushes such as the Black Survivor’s Coalition sit-in, the university has attempted to be more proactive when it comes to students’ wellbeing by increasing its mental health resources on campus, including adding new CAPS counselors, establishing HoyaWell (a university telehealth service), and encouraging professors to be more understanding when students are struggling. Yet, these efforts do not solve the underlying conditions that have caused student mental health to deteriorate.
So where do we go from here?
It’s clear that the fight for mental health justice on college campuses will be a long one, so it’s time that we start interrogating harmful leave of absence policies and their impact on student mental health.
The increase in students taking a leave during the pandemic must be the tipping point for destigmatizing the leave of absence process. No one should be considered weak or incapable for needing a break from the never-ending cycle of struggling at college. While leaves becoming more common has led to more positive views of the concept, medical or voluntary leaves are still not seen as a viable option among the student population.
“The feeling that I get from some people is this attitude of, ‘Oh, that’s great for you, take your time, but I could never,’ and it’s a little backhanded,” Rearick said.
In addition to the harmful student culture around leaves of absence, the administrative processes surrounding them must improve as well. Khan has seen instances where school administrators and deans don’t listen to the advice of counselors, let alone students, when it comes to making a plan moving forward. Ignoring students’ needs and the advice of professionals can lead to isolation, relapse, or even danger.
“I think what’s in the best interest of the student is to work on a safety plan that involves the students’ input and I think that’s a pretty basic demand to have,” Khan said. “Students can struggle to, but are also perfectly able to, articulate the specific nuances of their life and their needs and there can be an individualized approach that is specific to what a student’s circumstances are so that this blanket sort of policy doesn’t leave them stranded.”
Once students go on leave, faculty and staff must be committed to their rematriculation. The onus often falls onto the student to stay in touch with their deans and counselors. At Georgetown, students are even removed from school email lists, meaning important correspondence can fall by the wayside and students can miss information about housing, important COVID-19 updates, re-enrollment, and class registration. It is imperative that schools create a dedicated and individualized follow-up plan for each student on leave that ensures they are included in its drafting and execution.
Keeping communication open is especially important considering the red tape that exists in re-enrollment processes. At many colleges, students must submit a letter—typically from a doctor, employer, or community leader—confirming they are ready to matriculate again. In the case of mental health-related leaves, many universities require students to see a therapist; only
then do they have the ability to ensure your financial aid and student status are still intact.
“You can’t use the free doctors service— the counseling service as well—that are included in your tuition because you’ve been forced off campus, but you have to go to a therapist so that you can get back on campus and produce documents showing that you’ve been to a therapist or psychiatrist or someone similar,” Khan said.
“So this is kind of the paradoxical nature of the policy in that it’s claiming, ‘we’re trying to do this in the best interest of the student, because we are worried about their safety,’ but then it’s also removing every existing safety net that the student may have.”
At Penn, Rearick had health insurance for the first time in several years and could finally start reckoning with the mental health challenges she had been struggling with. When she went on leave and returned home to Florida, she had enough to deal with without worrying about the loss of healthcare she had only just received.
“There’s always a ton of red tape, always a ton of steps and processes that you have to go through to get things done and it makes it super discouraging to try to do things.For someone with mental health issues—in my case specifically, depression—that’s a lot,” she said.
It is unacceptable that a return can be conditional on pursuing treatment or being productive—especially in the midst of a pandemic. This just creates another barrier for those who can no longer use their best resources.
Yamakaitis notes the catch-22 of Georgetown’s stated and outward goals of promoting diversity and ensuring that anyone can have a place on the Hilltop with the lack of resources distributed to meet their needs.
“You accept all these students with all this adversity, and when you don’t expect them to need mental health care to deal with their trauma—that will always blow my mind,” he said.
Universities must be committed to sustaining students beyond their initial arrival. This support can— and should—take various forms. University healthcare resources, including insurance and mental healthcare, should still be available for students not currently enrolled. Students should not be fined for enrollment changes, and after taking a medical leave, they should be given adequate time to organize housing and other basic resources. Bureaucratic, application-based reinstatement processes must be eliminated and replaced with accessible and care-based plans that emphasize the autonomy of students.
The medical leave process must undergo foundational changes, but the work cannot stop there. Overhauling a single process without dedicating time and resources to marginalized groups on campus, often disproportionately impacted, would be meaningless.
Campuses today still rely on outdated structures and are not built to support students dealing with mental illness. To better support these students, university administrations must interrogate current policies and commit to making timely changes. A renovated leave of absence system certainly isn’t the only answer, but it can only make things better.
College students are exhausted, but they don’t have to be.
Health Education Services (HES): firstname.lastname@example.org
Counseling and Psychiatric Services (CAPS): (202) 687-6985; after hours, call (833) 960-3006 to reach Fonemed, a telehealth service; individuals may ask for the on-call CAPS clinician
National Suicide Prevention Lifeline: 1-800-273-8255