Medical leave provides struggling students with time away from campus, but hidden obstacles can complicate their return.

In May of last year, Maya* was finally able to admit she needed help. Her depression and anxiety symptoms had become much worse during her second year at Northwestern. She barely made it through winter quarter, earning grades far lower than she was used to. Completely overwhelmed and falling behind in her classes, she reached out to the Dean of Students Office in the latter half of spring quarter. It was then that Maya began the process of requesting medical leave.

After Counseling and Psychological Services (CAPS) interviewed Maya about her symptoms, a counselor laid out a treatment plan. CAPS referred Maya to an Intensive Outpatient Program (IOP) at a local hospital, but they didn’t provide her with any referrals for a psychiatrist, leaving her to navigate providers and insurance issues on her own.

“I felt like I was doing this all by myself,” Maya says. “Looking back, I didn’t even realize how alone I felt while [on leave].”

Still, she soldiered on and committed herself to treatment over the summer, believing she would be ready to return to Northwestern for fall quarter. She couldn’t have guessed that her attempts to return to the University would end up spanning an entire year and that her application for reinstatement would be rejected three times.

Understanding medical leave

According to the Northwestern Dean of Students Office’s website, “the purpose of a medical leave of absence is to provide students time away from campus for treatment of a physical or mental health condition that impairs a student’s ability to function safely and successfully as a member of our community.”

In the 2017-2018 academic year, Northwestern granted 155 medical leave requests, a 20 percent increase from the previous year. Between 100 and 120 students are reinstated after taking a medical leave each year. According to Student Assistance & Support Services, the majority of medical leaves are mental health-related.

There are a few key differences between taking medical leave and simply withdrawing from the university partway through the quarter. While medical leaves allow tuition to be paid back in full before the eighth week of classes, the University only gives full refunds for regular withdrawals within the first week of classes, and partial refunds between the second and fourth weeks. Medical leaves also provide later course withdrawals on students’ transcripts and can potentially grant international students the opportunity to maintain legal status in the U.S. while not enrolled in school. According to Senior Associate Dean of Students Mona Dugo, these qualities make Northwestern’s medical leave program unique compared to those at similar universities.

“There is no other school that I know of that gives tuition back and cancels out the transcript,” Dugo says. “Our agreement is that we will cancel out classes and give a tuition refund, but we’re really going to expect you to do treatment.”

After completing treatment as outlined by CAPS or Health Services, students returning from medical leave are subject to a strict reinstatement process in which they must provide documentation proving they have successfully sought treatment. Additionally, they must fill out an application, sit for an interview with CAPS or Health Services, and then make a reinstatement appointment with an assistant dean of students – and at the end of the process, they still might not be reinstated if CAPS or Health Services recommends otherwise.

“When a student takes a medical leave of absence, they receive a letter that specifies the course of treatment they have to engage in to return, and usually the treatment is more than individual therapy,” Dugo says. “We’re really trying to help students learn to manage significant symptoms. So during the course of a leave, we work with students to help them identify treatment providers, and then we really expect them to engage the treatment.”

A national reputation

Over the past decade, mental illness among college students has become increasingly prevalent. A 2018 study by Brigham and Women’s Hospital found that one in five college students has considered suicide. According to the Center for Collegiate Mental Health at Penn State, university counseling center resources devoted to “rapid access” (crisis appointments) increased by an average of 28 percent between 2010 and 2016.

As students turn to university resources during times of crisis, concerning trends have emerged in the way many schools, particularly elite private colleges, respond. In 2014, Princeton University made headlines when a student filed a lawsuit after being forced onto medical leave — and barred from campus — following a suicide attempt. In 2015, Yale University came under fire after a student referenced problems with the school’s medical leave and readmission policies in a Facebook status shortly before committing suicide. In 2016, NBC reported the story of a University of Chicago student who visited the student counseling center after self-harming, only to be placed in a psychiatric hospital for two weeks and compelled to take leave. Similar incidents have resulted in lawsuits against Stanford University, George Washington University and Hunter College, among others.

Unlike these schools, Northwestern does not compel students to take involuntary medical leave. Some students, however, report facing distorted incentives in deciding whether or not to take medical leave.

"It didn't seem worth it to stay"

At the beginning of spring quarter last year, Medill third-year Kevin Wilemski began to feel sick with what he assumed was a cold. After a few days, his symptoms significantly worsened. Wilemski eventually went to the emergency room, where he was diagnosed with mononucleosis. Recovery, he was told, would take around a month; he emailed his professors, explaining the situation and requesting permission to take his midterms after he’d recovered.

Wilemski was enrolled in three classes during the quarter of his illness. “Two of the professors were not thrilled but were kind of okay with it,” he says. “It was my professor for Intro to Microeconomics who said that she would not even consider letting me take the test [later].”

Despite having documentation from the emergency room visit to confirm his illness, Wilemski had no recourse in the face of his professor’s strict policy. To Wilemski, taking a medical leave of absence seemed like the only viable course of action, even though he would be fully recovered by the time the leave went into effect.

“You can’t really take a zero on something that’s worth thirty or thirty five percent of your grade and then continue the class, so my options at that point were either take medical leave and just go home, or else I’d only be taking two classes,” Wilemski says.

While medical leave would result in a tuition refund, dropping the economics class would bring him to part-time status, which can have ramifications for financial aid dispersal and student loan repayment.

“It didn’t seem worth it to stay and just take the two classes, which is why I ended up opting for a medical leave,” he says.

Outgoing ASG President Emily Ash believes that “the tuition forgiveness aspect [of medical leave] is fantastic and shouldn’t go away,” but that refund can leave students in a situation in which medical leave is much more financially feasible than less extreme measures, such as taking fewer classes.

“I don’t know that we couldn’t feasibly move to a tuition configuration in which that incentive distortion doesn’t exist,” Ash says. “There’s a strong financial incentive to go on full medical leave rather than switch to part-time."

"I feel like I'm flying under the radar"

When students opt for a medical leave, Student Assistance & Support Services (SASS) assigns them a contact from one of four assistant deans of students offices. While Wilemski describes his interactions with the SASS team members as positive and helpful, other students feel inadequately supported while navigating the reinstatement process.

When former Medill second-year Lillian Aff realized they had missed the application deadline to return to Northwestern for winter quarter by a day, they knew they had to talk to someone in the Dean of Students Office immediately. At the very least, Aff wanted to meet with their assigned SASS team member in the dean’s office to discuss their options.

“I called on a Monday, which was the next business day, and they wouldn’t even give me the time of day, even to have an appointment with [my team member],” Aff says. “They basically told me, ‘tough luck.’”  

A little over a year before, Aff marched through the Arch and started their first year as a journalism major. They excelled academically — receiving straight As throughout their first year — but struggled with depression, which worsened toward the end of freshman year. Shortly after classes resumed in the fall, Aff visited CAPS, where a counselor suggested they take a medical leave in order to pursue intensive treatment.

They returned to their home in Monte Rio, California, that fall, where they received treatment at a nearby hospital’s IOP. But as the months wore on, Aff became increasingly aware of what they perceived to be the University’s radio silence.

“I was under the impression that CAPS would be checking in and helping with things, but they didn’t,” Aff says. “I was really expecting a lot more support on NU’s end, or at least some kind of contact, and there was none. It didn’t feel like there was any follow-through.”

Dugo says there are simply too many students in the medical leave system to keep close tabs on each case. “We’re not involved during [the treatment] phase of things because that should really be between them and the treatment provider,” she says. “I don’t have the bandwidth to monitor students who are on medical leave. I’m always here for students who have questions, who want to meet with me, who want to call, who want to check in about things.”

“It’s extremely isolating,” says Aff. “Even though I have a few friends at Northwestern, I don’t feel connected to them because I’ve been in a limbo sort of state this entire time ... I don’t feel like this has helped me. I feel like I’m flying under the radar and forgotten by the University at this point.”

“Isolating” is also the word that Weinberg first-year Huma Manjra uses to describe her experience on medical leave this year.

“I had no contact with Northwestern anymore, except for my roommate and the friends I talked to,” Manjra says. “Nobody reached out to me — none of the deans, none of the CAPS therapists — to make sure I got into treatment and was doing okay. I just completely fell out of the loop.”

Manjra had already faced major obstacles in navigating the medical leave process by the time she returned home to Los Angeles in the middle of fall quarter this year. While she expected support from CAPS in securing the required treatment during her leave, she says she left campus with no plan in place and a list of potential providers who were unaffordable or unable to meet her needs.

“My CAPS therapist made it seem like I would find a treatment center right away, that they were very accessible, very cheap,” Manjra says. “[The CAPS counselor] was literally like, ‘Oh, here’s a list of treatment centers, you’ll find an opening, just call them when you get home’ … It was a very hard time for my family and I because, while I was going through my depression when it was the most intense, I had to also be online, look up treatment programs, call treatment programs, day and night, and figure out the insurance plans.”

The road to reinstatement

While undergoing treatment in Santa Monica, Manjra learned of another unexpected problem: Residential Services was trying to give her dorm room away. With her housing plan canceled at the start of her medical leave, Manjra had no guarantee that the room would remain open for her when she returned.

“I thought that was the most ridiculous thing I’d ever heard,” Manjra says. “Because if you have high anxiety, and experience depressive symptoms, you want to keep your environment as stable as possible when you get back.”

Like Manjra, Weinberg third-year Emma Latz faced challenges while applying to return to campus from medical leave during this year. As a global health major, Latz’s curriculum requires her to study abroad, which she spoke to her advisors and to CAPS about completing this summer. After being accepted into her first-choice study abroad program, Latz contacted the Dean’s office, who told her that she had to spend her first quarter after medical leave on campus and could not enroll in the study abroad program.

“I had already signed the contract to study abroad. I was ready to make that deposit, and then I was told I couldn’t,” Latz says. “I understand that there’s difficulty in communicating across departments … but I was very upset about that … I think that the University sometimes cares a little more about me as a liability more than me as a student.”

When Maya met with CAPS to develop a plan for her medical leave, she was given four requirements to complete over the remainder of spring and summer: an IOP, monthly therapy, appointments with a psychiatrist, and some form of substance use education. When she applied for reinstatement in August 2018, Maya thought she had completed all of the requirements.

She says the fourth requirement CAPS gave her was particularly vague.

“My IOP had this once-a-week day where we did an hour-and-a-half thing on substance use, and I figured that would be good enough,” Maya says.

At the end of her eight-week IOP, however, Maya’s point-person at the hospital recommended she undergo a substance use evaluation, “just to be safe.” But because she didn’t undergo an evaluation by the reinstatement deadline, Maya was denied reinstatement for fall quarter.

Dismayed by the setback, but still determined to return for winter quarter, she completed the substance use evaluation late in the fall. The result shocked her: the evaluator recommended she go through a second, substance-specific IOP. CAPS, upon receiving the recommendation, determined she would not be allowed to return until she’d completed it.

“It felt like they had added a requirement that wasn’t there in the first place and that I hadn’t agreed to when I left school,” Maya says. “CAPS’ Alcohol and Drug team viewed all of my materials – I never spoke to them personally, I’ve never met them, I have no idea who they are – and they decided that they would not let me come back without completing [the additional] IOP. And I never got the chance to give my input or speak to them.”

The denial came as a shock to Maya, in part because she didn’t consider her substance use to be problematic in nature. She says her evaluation results only indicated a few red flags, just enough to put her “on the fence” for concern.

“I felt really frustrated that they would not consider my preference because I feel like I should have a say in my own treatment,” she says. “And my therapist should have a say, but certainly not this Alcohol and Drug team that has never talked to me.”

According to Dugo, when treatment goalposts appear to have shifted, it’s often because evaluations or treatment reveal an underlying issue different from what was previously assumed. Most often, she says, this problem occurs due to potential substance abuse issues. Students with substance abuse symptoms along with other health concerns are at an elevated risk, she says.

“If they don’t go do substance abuse treatment, and I reinstate that student, there’s a very strong likelihood that they will need a second medical leave,” Dugo says. “The students who take a second medical leave, by and large, have substance abuse issues.”

Many of the students interviewed described the process of reinstatement itself as unnecessarily complicated and slow due to its reliance on the approval of a number of individuals from different offices and departments within the University.

Manjra had planned to take only distribution requirements during her first quarter back, hoping to set herself up for a successful return by avoiding difficult classes at first. She filled out the reinstatement application early in the quarter with the goal of having her registration hold lifted before course registration began. Her CAPS counselor, however, failed to reach out to her for weeks, which precipitated longer and longer delays in the process.

“First you have to go through a CAPS therapist, then you have to go through the Dean of Students, then you have to go through the Clinical Director of CAPS, and your own dean, and they finally clear you [to return],” Manjra says. “If the first person in that process doesn’t meet with me on time, everything else gets delayed. And that means you can end up missing class registration, that means you don’t know if you should book your flight or not.”

"A liability in their eyes"

Last month, Dugo spoke to ASG about the state of the medical leave program at their weekly Sunday meeting. At the gathering, Dugo cited increased financial support for students on medical leave as a flagship improvement. A major remaining challenge, she says, is the persistent overrepresentation of Black, Latinx, first-generation and low-income students among those who take medical leave.

“It’s hard when you’re coming from the perspective of someone who hasn’t had the same privileges as a lot of people at Northwestern,” Aff says. “Even on Northwestern’s insurance, I couldn’t afford to pay the $20 a week copays – my family doesn’t have that kind of money.” After spending two quarters away from campus, Aff decided not to apply for reinstatement this spring.

Maya says she feels fortunate that her parents were able to support her financially throughout her prolonged treatment process, as the cost of getting treatment while on leave could prove burdensome or prohibitive for many families. This spring, after receiving three consecutive denials for reinstatement, she was finally granted permission to re-enroll and finish her sophomore year. Had she known that the road to reinstatement would be so turbulent, Maya says, she still would have taken leave — the time away from classes took a substantial burden of stress off of her. But she’s still frustrated with the lack of agency she felt at various points throughout the road back  to reinstatement.

This summer, Manjra plans to work with Dugo to identify changes that can be made to improve the student experience for those on medical leave. One of their current goals is to redesign the medical leave page on Northwestern’s website to include a detailed FAQ section, along with videos of students talking about their experiences on medical leave.

More broadly, Dugo says she hopes to build a sense of community for students who have taken medical leave and returned to campus, noting that the stigma of explaining why they were away from school and the process of reintegrating socially can be an isolating experience for reinstated students.

“We’ve starting hosting reinstatement dinners this year,” says Dugo. “So every quarter, we invite all of the students from the year who went on medical leave and came back to a dinner, and just create some space for them to talk.”

Additionally, she plans to have special laptop stickers printed for reinstated students to help them identify fellow travelers around campus, and hopefully feel less alone in the process.

Still, the structural obstacles faced by students like Manjra and Latz can’t be fixed with a sticker. Neither regrets taking a medical leave; the time away from campus allowed each of them to focus on the treatment they desperately needed. But Latz says her experience left her feeling more cynical about reaching out for help through the University.

“It’s hard for me to see them ‘advocate’ for us, and say they care about mental health, and say that they’re going to work towards making it better at this university,” Latz says. “I feel like personally, I wasn’t super supported while going on leave, and that I am definitely a liability in their eyes.”

*Editor's note: name has been changed to protect student's identity.