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A closer look at Stanford’s leave of absence policies

Students who have faced suicide report that the University defaults to temporary campus withdrawal

Due to the number of sources who wished to remain anonymous, names of some students in this article have been changed. These students are identified by first-name pseudonyms.

Dean of Students Chris Griffith told Karen her behavior was negatively impacting the Stanford community. Jacob and Erik were told they required an unreasonable level of care that the University could not provide. Rose had become “increasingly dependent” on other students and was unwilling to seek help from mental health providers, and Sofia had placed too much stress on staff.

Each of these students was placed on a leave of absence, and each one is diagnosed with a mental health disability. Some of them have joined Disability Rights Advocates (DRA) in filing a lawsuit against Stanford, claiming that the University has practiced “punitive, illegal, and discriminatory treatment of students with mental health disabilities.”

Stanford refutes these claims, saying that University leaders conducted themselves properly when addressing these cases.  

The lawsuit, initially filed on May 18 and amended on July 16 to include the experiences of three additional plaintiffs, seeks modifications to Stanford’s policies surrounding leaves of absence and housing holds, rather than monetary damages.

The Daily examined the experiences of nine students — six plaintiffs from the lawsuit, and three additional students who agreed to speak to The Daily on the condition of anonymity — to discern how closely Stanford adheres to its own policies, how its practices interact with the law and how they impact students’ lives.

Police-enforced hospitalization

The lawsuit against Stanford claims that the University applies its policies on a “blanket basis” to exclude “students with mental health disabilities who are hospitalized” from academic programs and housing. In each case, hospitalization followed an incident of self-harm, suicidal ideation or a suspicion of either. Sometimes, this hospitalization occurs involuntarily.

Harrison Fowler ’22, one of the plaintiffs in the case who is currently on leave of absence, was forcibly hospitalized following an episode of suicidal ideation. Fowler, who has depression, had voluntarily admitted himself to Stanford Hospital before, where he was discharged to the outpatient clinic La Selva Mental Health Services. There, he reported, he was prescribed an antidepressant that severely augmented his suicidal ideation, leading up to his second hospitalization.

“I made this big commotion about how I didn’t want to go and I was blameless for the whole situation,” Fowler told The Daily. “I blamed the psychiatrist who prescribed me the wrong medicine, I was like, I’ll be fine, I can get through this, I’ll just switch to another medicine, and I didn’t think that going to the hospital would be the answer.”

Fowler reported that police officers then handcuffed him and brought him to Stanford Hospital, where he was later visited by his Residence Dean (RD) Carolus Brown. About six days later, still in the hospital, he signed a voluntary leave of absence form because he did not think he had any other choice. Despite his conviction, Stanford officials never explicitly pressured him to sign the form.

Olivia, who took a voluntary leave of absence at the start of her sophomore year, had a similar experience. After getting into an argument with a friend on the phone, she was handcuffed and brought to the hospital to prevent her from engaging in self-harm.

“I think [my friend] thought that since I was really depressed I was going to try something crazy, so he called the police on me,” she said. “I didn’t resist them, and still they handcuffed me in front of my dorm.”

According to Olivia, the police asserted that she was “clearly upset and agitated,” and thus needed to be hospitalized. However, she claims her distress was a product of the immediate situation, rather than her broader mental health.

“Obviously if four cops just showed up at my door, why wouldn’t I be upset?” she said.

Olivia also described the experience of being forcibly hospitalized by police officers as traumatic in itself.

“I will never forget what it felt like to have the police search me and handcuff me … The cops came in, they took all of my stuff, they undressed me, and it was just absolutely humiliating,” she said. “Now when I hear really loud footsteps, I get anxious; when I hear banging on my door, I get anxious; when I see police cars, I get anxious.”

After this experience, Olivia decided to take a year off. She was not pressured to do so by RDs, but feels she may have been if she had resisted.

“I don’t think it would have been much of a choice for me, so I told them I was going to leave anyway,” she said.

Technically, there is no rule against police-enforced hospitalization. The Jed Foundation, a nonprofit organization dedicated to the promotion of emotional health in teens and young adults, recommends it only “if necessary,” according to a 2008 report. The report, compiled by a number of lawyers and psychological professionals at various universities, details recommendations for university policies surrounding mental health.

At Stanford, once a student is voluntarily or involuntarily hospitalized, Residential Education (ResEd) gets involved. Each of the plaintiffs named in the class action lawsuit were quickly contacted by phone or visited in person by a RD while in the hospital. In each case, the RD alerted the student they were a cause for concern, and sometimes, that Stanford was considering putting the student on a leave of absence. It is at this point that the University begins to decide whether to put a student on leave. Often, the student remains in the hospital while this decision is made, and is asked to sign forms related to their student standing and housing status before they are discharged.

Making the Leave of Absence decision: discerning risk

Though the lawsuit claims that Stanford imposes a blanket policy, Stanford holds that it conducts an “individualized assessment” of each student’s situation.

Once this assessment proceeds, one of the criteria that may lead to Dean of Students Chris Griffith placing a student on leave is if the University determines a student “presents a substantial risk of harm to self or others or has engaged in threatening or violent activities,” according to the Dean’s Leave of Absence (DLOA) Policy.

In each of the lawsuit’s cases in which a mandatory leave of absence was imposed, the leave followed an actual suicide attempt, act of self-harm or vocalization of suicidal ideation.

The Jed Foundation’s report states that, in order to require a student to take a leave of absence, the University should apply the “direct threat” standard, under the American Disabilities Act.

“Significant risk constitutes a high probability of substantial harm, not just a slightly increased, speculative, or remote risk,” the report states, quoting from the Office of Civil Rights (OCR).

In its assessment of risk, the OCR requires that the university examine the “nature, duration and severity of the risk,”  “probability that the risky behavior will actually occur” and “whether reasonable accommodations or mitigating measures will sufficiently reduce the risk.”  

While Stanford’s practice mirrors consideration of the first two factors, the lawsuit takes issue with Stanford’s perceived failure to adequately consider reasonable accommodations.

For example, Jacob’s physician reportedly recommended he return to Stanford part time, but the University determined he should instead take a leave of absence. Jacob was hospitalized after experiencing suicidal ideation. Rose A., another plaintiff in the case, “was willing to do anything” to avoid taking a leave of absence, including taking a reduced course load and engaging in any form of therapy, according to the lawsuit, but she was still put on mandatory leave. Rose also experienced suicidal ideation, and engaged in non-suicidal self-harm.

The lawsuit also asserts that Stanford does not consider whether its actions would put the student at an even greater risk. Jacob believed that returning to his hometown in Utah would be of greater harm to his mental health, and Sofia B., another plaintiff in the case, has an abusive family, according to the court documents. Sofia’s parents reportedly did not speak to her during her leave, and told anyone who saw her at home that she was just visiting.

Still, University spokesperson Elaine Ray stood by Stanford’s claim that leave of absence decisions are made on an individualized, case-by-case basis.

“Each student’s circumstance is unique and decisions about their care would be made on an individual basis,” Ray wrote in an email to The Daily. Ray did not elaborate on policies surrounding hospitalization or leaves of absence despite The Daily’s multiple inquiries, and instead directed attention to the University’s published policies and statements.

In one of these, a “Notes on the Quad” statement by Vice Provost for Student Affairs Susie Brubaker-Cole published in response to the initial lawsuit’s filing in May, Brubaker-Cole acknowledged that “students’ mental health needs are extraordinarily diverse.”

“We are continually learning how to provide mental health resources that best meet the wide range of student needs,” Brubaker-Cole wrote.

Since offering comment, Ray has left her post at Stanford.

Some students voiced concern that Stanford’s practices surrounding a student’s return to campus following leave sometimes suggest that students are at fault for the risk they pose, despite that their struggles emerge from diagnosable disorders. Many critique Stanford’s practice of requiring students to provide personal statements before returning from leave discussing their “understanding of why [their] behaviors are of concern,” or “demonstrat[ing] insight into the impact of [their] behavior on others.”  

“I think [the personal statement] is ridiculous,” Fowler said. “[They are asking us to] take blame for what we did, not even what we did but what they did to us.”

Stanford’s assessment process: in print and in action

Though the DLOA policy states that a student will be notified when an assessment for a leave of absence is under review “where appropriate and feasible,” many of the plaintiffs or interviewed students reported that they did not receive notice of consideration to place them on leave until after a decision was made.

Instead, these students were notified by RDs that their mental health conditions were of concern, and later, a leave of absence was presented as a necessary action for them to take.

The DLOA policy also states that, if a student declines to take a voluntary leave, they will have the opportunity to respond to concerns raised about their well being before the Dean proceeds with the assessment.

In some cases, the distinction between a voluntary and mandatory DLOA is blurred, and students may ultimately agree to a voluntary leave of absence even if they do not want to.

According to the lawsuit, RD John Giammalva “coerced” Erik into signing a voluntary leave of absence form, telling Erik that he had not been released from the hospital because he had not yet complied, and “that it would be near impossible to return to Stanford without filling out the form.”

Sofia agreed with Griffith when she took a leave of absence without protest “because she thought she had no other choice,” according to the lawsuit.

“Sofia decided to do what Stanford told her to do so that her parents would not accumulate unnecessary tuition costs and she could return to her studies as soon as possible,” the lawsuit states.

If a mandatory leave of absence is imposed, students can appeal the decision in writing to Brubaker-Cole, according to the DLOA policy.

Tina’s appeal was successful following a three-hour conference call with administrators in which she was asked to explain how she would “remedy the damage done to the community,” according to the lawsuit.

However, Jacob, who submitted an appeal with a supporting letter from his psychiatrist, was denied, while Erik was “strongly discouraged” from appealing by RDs, according to the lawsuit.

None of the RDs mentioned in the lawsuit or by students responded to The Daily’s request for comment, instead directing The Daily toward University spokespeople.

“Exceed[ing] the resources” of the University

Another criteria in the DLOA policy for determining if a leave is necessary is whether the student “requires a level of care from the University community that exceeds the resources and staffing that the University can reasonably be expected to provide.”

In some cases, this decision is made before the student has attempted to use on-campus mental health resources, and the students were instead immediately admitted to Stanford Hospital after experiencing a mental health crisis.

This was the case for Erik, who was hospitalized after a suicide attempt and was later told the level of care he required “[exceeded] the resources and staffing,” that the University could provide, according to the lawsuit. Sofia, who was hospitalized following an anxiety attack, was also told she had “placed too much stress on [University] staff.”

Other students did take advantage of Stanford’s mental health resources. In Jacob’s case, the letter from Griffith notifying him of the decision to place him on a mandatory leave stated that Jacob’s “situation required a level of support from University staff and students that was unsustainable and for which they did not have the professional expertise to manage.” Prior to his hospitalization, Jacob had been regularly visiting CAPS.

CAPS, which functions as Stanford’s primary source of mental health care on campus, is meant to be a short-term counseling resource, providing referrals to outside care providers to students who need it after a maximum of about eight to 12 visits. In May 2017, The Daily found that the majority of students who use CAPS make only one visit.

This means that some students can face difficulty securing care — in Olivia’s case, getting treatment at CAPS after her leave of absence was difficult after three visits.

“After that I couldn’t have weekly appointments anymore because [CAPS] was overbooked,” she said. “So it became every other week, and sometimes every three weeks, and it became spaced out more and more … [sometimes] she would see me and she would be on call so maybe she would have to leave in the middle of our appointment.”

Rose tried CAPS before she went on her leave of absence, but was given referrals with care providers outside of Stanford after her initial intake interview. She was able to secure an appointment with a provider 14 days after she had called CAPS, but by that point she was already in the hospital.

Student privacy

Many students noted in the case and who were interviewed voiced concerns about confidentiality throughout the process of a students’ hospitalization and DLOA assessment.

In a statement published on Aug. 3, CAPS director Bina Patel reminded students that CAPS does not make “administrative decisions,” surrounding housing holds or leaves of absence.

However, the CAPS Confidentiality and Disclosure policy states that if a therapist is aware that a student intends to cause “imminent, life-threatening harm” to themself or others, they are legally obligated to “take whatever actions seem necessary to protect [the student] from harm.”

Moreover, the policy states that if a student visits the emergency room at Stanford Hospital for psychiatric care, Protected Health Information, which includes identifying information in a medical record, may be exchanged between providers to facilitate the continuity of care.

When Griffith convenes an Advisory Committee in the event a student has refused a voluntary leave of absence, the DLOA policy states that they may examine “relevant documentation made available to them” as well as confer with individuals “who have relevant information” concerning a leave of absence. These individuals may include a student’s RD, representatives from Vaden Health Center or CAPS, academic advisors, representatives from the Office of Accessible Education or other healthcare providers or university faculty.

This exchange of information between University faculty is protected by the Family Educational Rights and Protection Act (FERPA), which allows communication about a specific student between staff, faculty and administrators.

However, many leave of absence decisions are made on the basis of more information than this. The DLOA policy states that, in the event that the Dean of Students believes a clinical or psychiatric evaluation is necessary to perform the DLOA assessment, “Students are expected, if necessary, to sign a release of information to facilitate discussions between the University and the clinician conducting an evaluation.”

This happened to Karen, who ultimately took a voluntary leave of absence after attempting suicide. Karen had been hospitalized in San Francisco, and, according to her, releasing her medical records at RD Leigh Thiedeman’s request gave Stanford knowledge of her suicide attempt as well as her doctor’s psychotherapy notes.

Stanford also often requests information upon a student’s return from a leave. In Vivian’s case, the email she received from her RD after her discharge from Stanford Hospital, stated that, as part of Vivian’s “care plan,” ResEd would “like to” establish a Release of Information (ROI) between La Selva, CAPS and ResEd, to “allow [her] care providers to communicate any potential concerns and to create a more seamless experience for [her].”

According to Vivian, her RD told her that unless she released her medical records, she would be placed on leave.

ResEd made a similar request in both Jacob and Erik’s cases: when they created the stipulations for their return to Stanford from their current leaves of absence, they included an ROI that would allow Stanford to communicate directly with these students’ healthcare providers.

According to the Jed Foundation’s document, a University may require documentation in the form of an ROI that a student is attending counseling sessions if they are determined to be a direct threat. However, it also states that a University should not require a general medical release that gives full access to medical records.

Stanford’s policy in context

The DRA’s lawsuit against Stanford is part of a national investigation into university policies surrounding mental health disabilities. The DRA published a survey on its website that allowed students to enter their school, contact information and experience. The case against Stanford is the first lawsuit the DRA has pursued.  

“We did investigate numerous other universities to the extent that it enabled us to see that this is indeed a national issue,” said Monica Porter, the DRA attorney working on the case. “Stanford was the most egregious example that we found.”

However, the experiences of students at some of Stanford’s peer institutions, including Princeton, Hunter College, Western Michigan University, George Washington University, Marist and Quinnipiac, resembles that of students in the lawsuit. One Princeton student, identified as W.P. in the New Yorker, was forced to take a leave of absence in 2012 following hospitalized at Princeton’s University Medical Center after an attempted suicide. He filed a lawsuit against Princeton for discrimination, which Princeton filed a motion to dismiss, calling the lawsuit “patently meritless.”

W.P.’s mandatory leave followed his refusal of urges to take voluntary leaves, as well as a denied appeal to Princeton’s vice provost for student life. W.P.’s appeal included a note from his private psychiatrist that stated that he did not pose a threat to himself, and that a leave of absence could be “detrimental to his health and well-being.” However, Princeton asserted that his enrollment would cause an “unacceptably high risk of substantial harm to [his] health and safety that cannot be mitigated by any reasonable modifications,” according to the article.

Another student, Jackson Peebles, sued Western Michigan University (WMU) in 2013, alleging that the university discriminated against him for his depression and anxiety issues by denying him reentry to his classes and dorm room following his week-long hospitalization for suicidal tendencies.

WMU asked to voluntarily resolve the complaint, agreeing to revise its policies surrounding student-conduct and removal of students.

Jordan Nott, who attended George Washington University (GW), filed a lawsuit in 2005 against the university alleging that GW had banned him from campus and class following hospitalization as treatment for his depression, and that the university’s policies are discriminatory against those with mental health illnesses. Nott received an interim suspension after admitting himself to the hospital after experiencing suicidal thoughts. The following year, the lawsuit was settled out of court.

Facing forward

As of now, the DRA is in conversation with Stanford to move towards making steps towards settlement discussions.

“We do remain very willing to work with Stanford and their counsel to address these policies and ensure that students with mental health disabilities can be accommodated,” Porter said.

In Brubaker-Cole’s “Notes on the Quad” statement, she wrote that the Student Affairs Mental Health and Wellbeing Advisory Board will begin to roll out recommendations for improving student mental health resources in the fall.  

Brubaker-Cole also wrote that, for two months prior to the initial May filing of the lawsuit, Stanford was engaged with the DRA regarding their concerns, during which the University established an interim housing hold policy that includes more specific guidelines for the “review” of a student’s housing status, and that also details an appeals process for the student should they lose their housing. Brubaker-Cole also reported that Stanford was continuing to communicate with the DRA when the lawsuit was filed.

However, Porter claims that this is a “mischaracterization.” Instead, Porter stated that the DRA reached out to Stanford in advance of filing the lawsuit in hopes of avoiding pressing charges altogether, but Stanford was “unwilling to enter into negotiations that would recognize the systemic nature of the problem,” she said. She also said that Stanford had not been in contact with the DRA for “at least two months” prior to the initial May filing.

Regardless, the filing of the Amended Complaint has called further attention to the concerns.

“We determined that now was the time to have the most fruitful conversation moving forward with Stanford to make sure we [are] really focusing on this being a systemic issue rather than being one that has only impacted a couple of students,” Porter said.

 

Correction: A previous version of this article stated incorrect settlement terms for Jordan Nott’s George Washington University case. The Daily regrets this error. 

Hannah Knowles and Brian Contreras contributed to this report.

Contact Julia Ingram at jmingram ‘at’ stanford.edu.

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