When Colleges Fail at Mental Health

The Dismal Academic Record

These stories include mentions of suicide. If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). Find additional resources at SpeakingOfSuicide.com.

By Abigail Napp and Harsha Nahata

Luchang Wang was supposed to graduate from Yale University in 2017.

As a sophomore, she struggled with mental health issues. She enrolled in classes and then had taken time off to deal with her struggles. Now she feared that if she took another break, she would never be allowed back to a college she treasured.

The passage would stand as her suicide note.

No one knew where she was in the hours after she posted it. She had flown back home to California, and apparently jumped off San Francisco’s Golden Gate Bridge.

She has not been the only student at Yale who felt pressure over whether to seek mental health care and risk being allowed to continue their studies. And Yale is far from alone among universities.

America’s teens and young adults report record levels of mental-health issues, and college counselors are reporting ever-increasing demand for their services. The demands have only escalated with the coronavirus pandemic. The federal Centers for Disease Control are encouraging universities to ramp up counseling for students feeling overwhelmed. At a time of social distancing and remote learning, tele-counseling services offered by universities across the country are a key hope for assisting displaced students.

Yet even in the best of times, when students have direct physical access to campus resources, universities have had difficulties providing mental-health services to their students. Filings with U.S. Department of Education’s Office of Civil Rights show more than 50 substantiated cases in the past five years in which universities fell short of federal law when it came to helping at-risk students.

 At universities across the nation, leave-of-absence policies have been found to discriminate against those with mental-health disabilities, public records show.

Federal filings show professors ignoring required accommodations for students with certified special needs, universities not having enough staff to help those with mental illness, and schools not providing counseling for victims of sexual assault, a population that is particularly susceptible to mental-health problems. 

 The past few years have also seen organized actions on campuses where students have complained about inadequate counseling services. In October, students at HACC, the largest  community college in Pennsylvania, voiced their concern after on-campus counseling services were eliminated, and the school admitted missteps conveying the plan while assuring students they will continue to get services. At Yale, Stanford, Princeton and other universities and colleges, forums have been organized to discuss complaints about counseling.

Department of Education documents are one of the few, limited windows into the secretive world of how the nation’s more than 4,500 two- and four-year colleges handle the mental-health challenges that may be encountered by their 20 million students. 

While universities are not responsible for mandating a student’s medical care, federal law requires that they do not discriminate against those who suffer from mental-health issues. Universities are also required to make reasonable accommodations to allow these students to succeed, as covered under the Americans with Disabilities Act as well as section 504 of the Rehabilitation Act of 1973, which outlines required adjustments for those with disabilities.

Every year, universities face hundreds of official complaints that they are violating these laws. Complaints can be filed in federal court and with the Department of Education’s Office of Civil Rights. To be sure, complaints involving mental health are a small number of those filed with the agency.

Cases are typically handled behind closed doors under medical privacy laws. Settlements of Department of Education complaints do become public. Lawsuits shed additional light on disputes.

Six students sued Stanford in a 2018 class-action case, arguing they were forced to put their education on hold for months or a year because they had told university officials about their mental health problems.

One student, cited anonymously in the litigation, said that after she reported having suicidal thoughts, Stanford threatened to expel her if she did not take a year-long leave of absence.

“Going to Stanford was my dream, but this has felt like a nightmare,” wrote the student, identified only as Rose A. After having suicidal thoughts and contemplating hurting herself, Rose was hospitalized nearby. She said Stanford officials threatened to expel her if she did not take a year-long leave and that she was barred from returning to her dorm. She remained in the hospital until her parents arrived from Australia. She said she was not offered any accommodations, like a reduced course load or an option to live on campus. A residence dean allegedly told her, “it’s too late now.”

Another student wrote in the same court filing that he, too, sought therapy for suicidal thoughts, got treatment and was banned from his dorm. Then he needed to pay a $450 fee as part of being barred from returning to his dorm.

In a 2014 survey of 500 Stanford students, almost a third said they suffered from depression, according to one document submitted as evidence in the lawsuit. Half of the students said they felt they reached stress levels that they ranked as seven or eight on a scale of one to 10.

Stanford settled the class-action case in October, agreeing to alter its leave policies so students would no longer be required to depart the campus for up to a year and acknowledging that a leave will be considered only if a campus mental-health expert has determined all other accommodations have been exhausted. More case managers are being added to help students with mental-illness concerns. Additional funding will be allocated for counseling services. Students would also be informed about their right to not forfeit tuition fees should they take a leave of absence.  

The Stigma That Follows Students

At Princeton, a student sued because he was forced to leave the campus after a suicide attempt. Referred to only as W.P., he said he sought help from school counselors and attended group therapy sessions during his first semester.

Then,  at the beginning of his second semester, on Feb. 25, 2012, he felt he could not cope. He swallowed an overdose of his antidepressant medication. He instantly regretted the decision and tried to vomit out the pills. He sought help and was sent to the school’s medical center.

After a month, his psychiatrist said he was fit to return to school. Instead, Princeton officials told him he could not come back for at least a year and he was urged to voluntarily withdraw. If he rejected the deal, he said he was told, he would be forced to withdraw and would not be entitled to a tuition refund. In addition, his transcript would be marred with a note that his departure was a “mandatory withdrawal.”

He left and was readmitted the following year. In his suit, he reported anxiety and stress about the need to explain to prospective employers why he was not in school for a year. His complaint also alleged Princeton had no published procedures for cases like his.

 The legal battle went on for five years and was settled in the summer of 2019 on undisclosed terms.

Chronic Staff Shortages

Lack of counselors and adequate staffing is a concern echoed across the country.

The University of Virginia agreed to hire more mental-health counselors after a U.S.Department of Education investigation found that its handling of sexual-violence complaints violated federal standards. Philadelphia’s Moore College of Art was found by the OCR to not properly staffed its position overseeing accommodations for disabled students nor had it provided students with consistent information about who to contact with disability concerns.

A spring 2019 survey of more than 50,000 undergraduates by the American College Health Association, a group of campus counselors and other health professionals, found that more than 57 percent of undergraduates reported feeling hopeless in the past year, and 88 percent reported feeling overwhelmed. More than 60 percent said they had felt “very lonely” and 46 percent they had felt so depressed that they found it difficult to function.

A National College Health Assessment survey of nearly 200 counselors and students reported that students’ mental-health problems were made worse because universities did not offer enough help.

In a comprehensive report published in 2017 by the National Council on Disability, 47 percent of mental-health practitioners said the lack of funding limited campus services“impeding the success of students with mental health disabilities.” One third said counseling services “were not adequate.” Only two respondents out of 101 said their colleges offered “comprehensive services.”

While counseling centers have generally increased services for urgent cases like threats of suicide, the 2018 Center for Collegiate Mental Health survey found that from fall 2010 to spring 2016, colleges overall offered fewer services for routine treatment.

For students needing to see a psychiatrist or a counselor over the weekend, the situation can be even more dire. More than half of the 571 counseling centers surveyed by the Association for University and College Counseling Center Directors do not offer psychiatric services. Less than five percent of counseling centers offer clinical appointments on weekends, and the average wait for the first appointment was 6.5 business days.

Barry Schreier, a counseling director at the University of Iowa who serves on the board of the Association for University and Counseling Center Directors, said his organization’s data shows students are reporting more mental health needs, and they are using far more services.

 “These are staggering numbers,” said Schreier. “It points a lot to the level of distress our students feel.”

Part of the reason may be that so much has been done in society to reduce any stigma around seeking mental health care, he said.

 “The demand for services appears bottomless,” said Schreier.

The Ways Schools Fall Short 

Federal records show at least 11 substantiated complaints, like those cited in the survey, against universities for failing to provide accommodations for students with mental-health disabilities.

At Orange Coast College in Costa Mesa, Calif., an Iraq War veteran suffering from bipolar disorder and post-traumatic stress disorder found that his request for accommodations was, needlessly delayed for months, according to investigators. Even when his needs were finally certified, one teacher refused to let him refer to his notes during a final exam, one of the approved accommodations.

The University of Missouri-St. Louis failed to make accommodations like providing a note taker. While a student in a math class had an accommodation that called for having a note taker, that person quit during the semester, and no one was hired to continue the job. The ensuing dispute led the university to overhaul and update its procedures for providing accommodations. “There have been multiple steps taken in recent years with the intent of bettering student mental health on our campus,” the school told the News Service.

In 2013, a Houston Community Central College professor ignored a student’s approved accommodations. The case led to widespread changes on the campus. The school signed a dispute resolution agreeing to overhaul how it treats students with disabilities. All faculty and staff who work with disabled students would undergo mandatory anti-discrimination training. The school revamped its policies and made clear that it allowed accommodations for those who need them. An appeals process was clearly spelled out.

The Plight of Sexual-Assault Survivors

 
Students who suffer from anxiety, depression, PTSD and other disorders are more likely to also be survivors of sexual violence, according to a 2019 survey by the Association of American Universities of more than 180,000 students on 33 campuses. Yet  more than a dozen universities have faced accusations of failing to provide appropriate mental-health services for victims of sexual assault.

The list includes Michigan State University, where Larry Nassar, who served as one of the school’s sports doctors, was convicted in 2016 on child sexual assault and pornography charges, stemming in part from his work with USA Gymnastics, one of the most notorious cases of sexual assault in recent history.

As part of a settlement, Michigan State agreed to a series of policy changes—including making clear to students who allege they suffered sexual assault that they are eligible for counseling and mental health services.

In separate cases, Carthage College in Wisconsin, Citrus College in California, Minot State University in North Dakota and Southern Virginia University agreed to policy changes after federal complaints so mental health and counseling services are offered to students after sexual assault.

Frostburg State University in Maryland was required to review all sexual-harassment complaints from 2010 to 2016 to determine if it properly conducted investigations. As part of a settlement of a federal complaint, the school was required to offer “counseling and other appropriate services” to at least 26 victims where the university failed to document whether help was offered when they filed their complaints.

The University of Virginia agreed to hire more mental-health counselors in the wake of a federal investigation into how it handled sexual-abuse cases.

Princeton was found to have fallen short in providing mental-health support to victims of sexual violence and abuse. In May 2019, students protested how sexual misconduct was handled on campus. Princeton formally updated a series of policies in October after two reports authored by committees found, among other shortcomings, that navigating the Title IX process was “daunting or confusing.” The reports asked for an expansion of staffing and programming on Title IX, including more support resources for students and the creation of an emergency fund working group to make sure that there was enough funding and attention being given to the mental health needs of students.

What Schools Should Be Doing

Advocates believe universities can be doing more.

The Bazelon Center for Mental Health Law, based in Washington, D.C, has sued colleges for failures to help those with mental health issues.

It filed suit in 2019 against Brown University on behalf of a medical student suffering from depression and attention deficit disorder who was allegedly forced out of the school without any attempt to accommodate her condition. The case is pending.

In the past 15 years, it has won a $165,000 settlement from CUNY’s Hunter College after a student was barred from campus after being hospitalized for a suicide attempt. It won a settlement against Palm Beach State College after the school “made inappropriate inquiries” about the student’s mental health after she asked for a service dog. And it obtained a confidential settlement against George Washington University after it objected to a student returning to campus when he reported feeling depressed after a close friend committed suicide.

Bazelon promotes a model policy for universities to support students with mental health needs, including avoiding punitive measures against students who suffer from a mental health crisis and allowing students to continue their studies as soon as is reasonable.

It also provides guidebooks to students about their rights to privacy in mental health matters, how they can seek accommodations. It has helped train students on knowing their rights as a person with a mental health disability, so they know the law as its written and how to get legal representation.

The JED Campus Foundation, a nonprofit based in New York City that works on suicide prevention and emotional health across campuses, has worked with 215 institutions of higher education.

Diana Cusumano, a staff member at the JED Foundation and is a former college counselor, said the university counselors she’s spoken with are overwhelmed and overloaded by the increasing demand for their services on campus.

As schools seek to be more proactive about helping students, she said it has become harder for colleges to provide enough psychiatric care to students.

“One thing we’ll see helping the field is tele-health and tele-psychiatry as we go into this new decade,” said Cusumano. “I think this could be a good opportunity for places in rural areas.”

Advocates recommend that universities use surveys to better understand students’ needs and encourage schools to train every employee to identify students at risk.

“Ninety percent of [the problems of mentally disabled students] would go away if colleges would help people,” said Julia Garrison, a Bazelon Center lawyer. “The law is the bare minimum of what people have to do not to discriminate against people with disabilities. That doesn’t mean people can’t go above and beyond and ask for more than what the law requires.”