Stanford’s New Policy for Student Mental-Health Crises Is Hailed as a Model

Students are regularly urged to reach out for help if they are suffering from anxiety or depression, thinking about suicide, or struggling with other mental illness. But when they did that at Stanford University, according to a class-action lawsuit brought last year, they were often coerced into taking involuntary leaves, or leaves that were “voluntary” in name only — even banned from the campus without being allowed to collect their belongings from their dorms.

A settlement of the suit this week is being hailed as a landmark. Legal and medical specialists as well as mental-health advocacy groups say that Stanford’s new leave policies, which will take effect on January 4, are a model of student-centered, compassionate, detailed, and transparent practices.

In court documents, students said they had been falsely accused by administrators of disrupting the lives of their friends and had generally been treated as if they had committed behavioral infractions rather than simply asking for treatment, in an appropriate manner, for their disabilities during times of crisis. The university’s actions, the plaintiffs said, made them and their classmates less likely to seek the help they needed. One student has “observed over the past several years that if a Stanford student is involuntarily hospitalized for mental-health treatment, they effectively disappear from campus.”

In its court-filed answer to students’ complaints, Stanford disputed many details, sometimes because it “lacks knowledge or information sufficient to form a belief as to the truth” of allegations, “and on that basis denies them.”

The settlement involves no admission of liability by Stanford or the plaintiffs, and in it the university agrees to pay the plaintiffs’ $495,000 in legal costs.

‘An Egregious Example’

“We pursued Stanford because it was an egregious example,” said Monica Porter, a staff attorney with Disability Rights Advocates, a nonprofit organization in Berkeley, Calif., that represented the students. But she said that unfair and uncompassionate leave policies are “widespread” and that the organization continues to collect information on its website about leave policies and practices at other colleges.

These are among the changes resulting from the Stanford settlement:

• Students will have two business days to change their mind after agreeing to a voluntary leave.
• The university will make appropriate accommodations, in reviewing leave and other options, for students who are hospitalized.
• Involuntary leave will be treated as a last resort after discussion of reasonable accommodations, which could include reduced courseloads, changing dorm rooms, and other options. These will be brainstormed in consultation with a mental-health specialist in the university’s Office of Accessible Education.
• The university will give significant weight to the students’ primary treatment providers.
• Students may petition to retain their campus housing when on leave for a term. This is important, Porter said, because some students have housing insecurity or their family homes are unsafe or un-therapeutic for them to return to. This policy will put them on an equal footing with students being treated for cancer or other illnesses who are allowed to remain on campus.
• When a student wishes to return from an involuntary leave of absence, Stanford will assess whether the student is ready and able to return to the university with or without reasonable accommodations.
• A resource person, familiar with the policies but outside the decision process in a particular student’s case, will be made available by the university to advise the student facing choices about leave, during that leave, and returning from the leave.
• Stanford will provide staff members with training on mental health and the new leave policies.

Peter F. Lake, a specialist in higher-education law at Stetson University, said the settlement was in keeping with recent court decisions casting colleges in a special relationship with students, including reasonable and compassionate responsibility for their guidance and welfare, as well as evidence-based solutions applied in a case-by-case manner.

The fact that the new policy was reached by settlement only makes it stronger, Lake said, because it suggests that all parties involved recognize new social and clinical norms toward those suffering from mental illness. The transparency and detail of the new policy, he said, would strengthen — not weaken — Stanford’s position and potentially limit its liability in the case of a student’s suicide, self-harm, or other incident.

Karen Bower, a lawyer in Washington, D.C., who specializes in cases concerning discrimination against college students with mental illness, called the new policy “very comprehensive and transparent.” It clearly deems involuntary leaves as a last resort, she said, with the provision of a resource adviser to the student and the two-day revocation that enables and encourages students’ involvement in the decision. The settlement “gives other universities a lot to think about” in examining their own policies, she said.

And many colleges have been doing so.

“We review these processes yearly,” said Jeanne S. Hart-Steffes, vice president for student affairs and dean of students at Western New England University. “The Stanford settlement gave us another opportunity to talk about this policy,” with an emphasis on seeking out student-support systems on and off campus.

Karen Morgan is associate dean of care in campus life at Texas Christian University, a newly created job there to advocate for students and manage their concerns and crises. For example, the office helps students communicate with faculty members about absences that may be related to health conditions and to support students as they arrange doctor’s appointments, housing, and other logistics. In its leave policies, Morgan said, “we want to make sure that we are consistent with how we approach students who have any medical issue.”

Harrowing Accounts

Multiple students describe Stanford’s previous approach to leaves of absence in court documents.

One student, Harrison Fowler, said that he had experienced “the worst suicidal ideation I have ever had” as a side effect of an antidepressant. He reached out for help to his resident assistant, who called Counseling and Psychological Services. “I told CAPS that I was feeling suicidal, and CAPS called the police, who came to my dorm, handcuffed me, and took me to Stanford Hospital,” he said.

While there, Fowler said, the residence dean “visited me to talk about a leave of absence, telling me that I was most likely going to have to take a year off. I tried to explain that it was not necessary, that I had been on the wrong prescription, and that it was not good for me to go to Beaumont [Texas], where I am from. I begged him.” The dean “told me that the decision was not his or mine to make, and that he had to speak with higher-level administrators. He never provided me with an update.”

Fowler’s statement goes on to describe a meeting at the hospital to discuss his discharge plan, at which the dean and a representative from CAPS presented a year’s leave of absence to the doctors as a fait accompli, leading Fowler to believe that he would not be discharged until he signed the leave form.

Preventing Suicide Contagion

No college wants to plan for the aftermath of a student’s suicide, but not to, experts say, is reckless and dangerous. “Postvention” guidelines on how best to notify students, handle mourning and memorials, and offer counseling might play a crucial role in averting suicide clusters.

• A Postvention Primer
• After a Suicide, What Colleges Can Do to Protect the Public Health
• Resources for Handling Suicide’s Aftermath

Another student, Jacob Z. (a pseudonym used in the court documents), was walked by his roommate and another friend to the health center after experiencing suicidal ideation “while adjusting to a prescribed medication as part of his mental-health treatment.” While still in the hospital, “a residence dean visited him,” the court document says, “and told him that he had caused his dormmates psychological harm,” that he had been “a disruption to the community,” and that “it was unfair for him to impose a burden on other students and staff.” He “threatened Jacob with legal action and a ban from his dormitory.” Jacob’s friends later assured him that the residence dean’s “statements about the impact he had had on them were not true.”

A third student, Rose A. (again, a pseudonym), was hospitalized after suicidal ideation and nonsuicidal self-harm. In her second day in the hospital, a residence dean called and told her that she would have to leave the university for a year through the dean’s policy on leaves of absence. “He also told Rose that she would have to improve her behavior in order to improve the outcome. When Rose began crying at this news,” the residence dean “accused her of sounding hysterical and attempting to manipulate him.”

Sofia B. (also a pseudonym) was hospitalized for an anxiety attack. A university administrator “visited Sofia in the hospital and told her that she had to take a leave of absence because she had placed too much stress on staff and been disruptive to other students.” Sofia was forced to take a leave even though she said that she had “an abusive family and that going home would be detrimental to her mental health.” She lived with her family for the winter quarter, “during which they would not speak to her.”

After returning, “Sofia has not had any other interactions with” residence deans or that administrator, the court document says. “She tries to stay very quiet now.”

Some administrators named in the students’ complaints did not return Chronicle requests for comment or could not be reached via the university.

‘The Right Direction’

Students now hope that such experiences will be a thing of the past.

“We’re really happy with the settlement,” said Caroline C. Zha, a senior and co-director of the Mental Health and Wellness Coalition, in an interview. She said the new policy will remove the punitive elements and emphasize that students with mental disabilities are not a burden to those around them or to the university. “I hope this settlement,” she said, “makes students feel like they’re in power to take advantage of these resources and to advocate for themselves.”

In a statement to The Chronicle, Susie Brubaker-Cole, Stanford’s vice provost for student affairs, said the university was pleased to have reached an agreement. “We strongly believe the new policy provides an excellent framework for everyone as the university enhances mental health and support for the safety and well-being of all students.”

Mental-health advocacy groups also greeted the settlement warmly.

“This is a great step in the right direction,” said Marisa Giarnella-Porco, president and cofounder of the Jordan Porco Foundation, a suicide-prevention organization, “and will hopefully encourage other colleges and universities to re-examine their policies and make changes that are more compassionate and student-centered.”

Harrison Fowler, now a sophomore thinking of majoring in political science and African and African-American studies, said by phone: “I was really excited to find out about the settlement. … Now what happened to me won’t happen to anyone else.” He said other students had thanked him for speaking up about his situation. And, despite his experiences, he called Stanford a college “of many opportunities.”

“I wouldn’t want to be anywhere else but here.”

Alexander C. Kafka is a Chronicle senior editor. Follow him on Twitter @AlexanderKafka, or email him at alexander.kafka@chronicle.com.