Leaves of absence are fairly common at Brown. But for some students taking medical leave for psychological reasons, miscommunication and frustration with the University dominate the experience.
The long road back
Okezie Nwoka was a member of the class of 2010, but in September 2008, he consented to deans' suggestions to take medical leave. Since then, his status as a student has been in flux and his graduation year uncertain.
"I entered into a manic state and was classified as bipolar," Nwoka said, describing the reason for his first medical leave.
Under the assurance that he could return when he was ready, Nwoka began his treatment in Washington, his hometown, with a therapist and a psychiatrist while also working at a consulting firm.
Though he attempted to return the next semester, he was urged to take another semester off.
Students can apply for readmission at any time, but most leaves for psychological reasons are longer than one semester, said Belinda Johnson, director of psychological services.
"The important thing is that the student gets the appropriate help," Johnson said.
In summer 2009, Nwoka experienced another manic episode and his fall readmission to Brown was revoked, he said. He was allowed to return in January 2010, under the condition that he would follow a treatment plan, a basic requirement for most students returning from medical leave.
But once on campus, Nwoka could not go to a psychiatrist to obtain his medication because his insurance did not have coverage in New England.
Instead of seeking aid, "I tried to manage the medicine I did have by using it sparingly," Nwoka said. "I was afraid that I would be placed back on medical leave if they knew I didn't have a doctor."
"The University requires all students to have medical insurance prior to registering," wrote Associate Dean of Student Life Maria Suarez in an e-mail to The Herald. "If a student finds him or herself with limited coverage, the (Office of Student Life) works very closely to help them acquire the necessary coverage."
Nwoka's attempts to avoid medical leave were thwarted after he experienced another episode at the end of last semester.
Though he had successfully completed his finals and sought help himself from psychological services, Nwoka said, he was informed in early June that his status as an active student was being reconsidered in light of his recent episode.
He was asked in August to submit letters written by himself, his doctors and his employer to determine whether he could enter as a student in the fall. Communication from the University was sparse, he said.
"Brown really didn't keep in touch with me," Nwoka said. "It was more me calling to see when I had to reapply for admission."
As the beginning of this semester approached, he was still uncertain of his status because his doctor's letter did not arrive until Sept. 1.
A week later, Nwoka met with Suarez to discuss his situation. "I was informed that I was officially on medical leave," Nwoka said. A couple days later, a letter notifying him of his status change was sent to his home in Washington.
Mandated medical leave, Suarez said, is only enforced "if it becomes clear that the student is a risk to themselves and others."
The reason for his mandated leave was explained to him in different terms, Nwoka said.
"Although it was four months ago and I have two letters from doctors saying that I'm ready, they want to see a longer period of sustained recovery," he said. "I think if Brown is going to make that decision, then they need to do the same work or more than the doctor they are disagreeing with."
Johnson said the emphasis on a student's period of sustained recovery is to "avoid bouncing back and forth."
"The way that I have been placed — juggled around in the system — shows no commitment for us to have a timely education," Nwoka said.
‘Going at it alone'
Another student entered Brown in 2004. She was having trouble adjusting to college life and chose to go on medical leave beginning in spring 2006. She returned two semesters later, but school had not become easier.
The student requested anonymity because she did not want to be associated publicly with her story.
After another two semesters, "I was having trouble adjusting to life here and it was decided for me that I should go," she said.
Thinking that her leave would be for just one more year, she attempted to apply for readmission in January 2008. But miscommunication on the terms of her leave led to a rejection of reentry. She said she was denied because she had not taken classes while on leave and had not worked with a therapist enough.
"I was completely blind-sided," she said.
She said she had spoken with a former associate dean of student life about taking classes when she was first placed on leave, but was advised to focus on rehabilitating herself.
"I took (the dean's) word for it," she said.
"We are really aware that when a student takes a medical leave, that tends to be a highly emotional time for the student, so it is very possible that they do not absorb everything that was told to them," Johnson said.
"The biggest problem was not having more guidance, no specific place to help you through, to guide you," the student said. "I was already off campus, already disconnected. I didn't hear from anyone until I had to reapply."
"I felt that I was going at it alone," she said.
‘Ambiguity … is rough'
Three types of leave are available to Brown students: personal leave, medical leave and academic suspension. The last case, according to Peggy Chang '91, director of the Curricular Resource Center, is rare since many students decide to take a personal or medical leave before facing suspension.
University policies for medical leave and involuntary leaves of absence are not currently available on the Office of Student Life's website.
"We are constantly revising our documents and are currently in the process of completing the most recent changes," Suarez wrote in an e-mail to The Herald. She wrote that she would release them once their latest form is approved.
Ernestine Jennings, assistant professor of psychiatry at the Alpert Medical School, said a lack of clearly stated protocol can hinder students' efforts in treatment.
"Ambiguity for that person in recovery is rough," Jennings said.
A ‘rewarding experience'
For some students who went on leave, like Chris Mendez '10.5, the distance that the University kept during their leave of absence was not an issue.
"Primarily, I was experiencing a lot of frustration with academia," Mendez said, "an internal crisis with what I was pursuing and what I want to pursue after."
"But the straw that broke the camel's back was that I was experiencing symptoms," he said, referring to the multiple sclerosis diagnosis he received at the end of his sophomore year.
Though his decision to take leave was in part influenced by his medical condition, his was recorded as a personal leave.
"The dean didn't see any reason to put it down as a medical leave," Mendez said, "because to do a medical leave you need more paperwork."
In terms of communication, Mendez heard nothing from Brown until he had to confirm he was returning in the spring.
"All in all, it was an extremely rewarding experience," he said. "I couldn't be where I am in my academic career had I not pursued these interests.
Nwoka and the female student both said they felt the resources available to them were insufficient.
"Maybe if there were check-ins, even generic e-mails," said the female student. "It would have been nice to have felt that someone was there.">
"The system is so distant," Nwoka said. "There should be people in Psych Services to check in with students so that students don't feel afraid to talk to them about what's going on."
"I wish we had more resources to connect with students," Suarez said. "The support is there, but it is student-initiated."
Johnson said a former Office of Student Life support staff member would contact the students on leave to ask them about their decision to reapply.
"She was really conscious about follow-up," Johnson said, going "far beyond what (was) supposed to be her job."
Staff is another limited resource at Psych Services.
According to the office's website, there are six full-time, five part-time and one on-call clinical staff. A new psychotherapist was hired this semester, raising the number of allowed appointments per student from five to seven a semester.
Both sides, another way
Mental health is clearly a complex condition to assess, especially when multiple needs are involved.
"The situation that arises is that as an institution we are trying to support students," Johnson said. "It doesn't come from a place of rigidity. Let us as staff with experience help you out."
But there is a need for student voices to be heard within this process, Nwoka said.
"What matters from a university's perspective still needs to be looked at from a student's," Jennings said.
"It's a very unnerving process," the female student said, "and a very ironic process. It puts a lot of stress on us."
"I think it is unjust," Nwoka said. He said the episodic nature of bipolar disorder makes it hard to assess recovery. "What does sustained recovery mean for people like us?"
Though "involuntary leaves are extremely rare and assessment is highly individualized," Suarez wrote, another option for treatment is needed.
"Why does that recovery process have to take place off campus?" Nwoka said. "There should be more collaboration with the student and the administration. Whoever is evaluating the student should also work in conjunction with outside doctors."
About 70 students go on medical leave for mental health concerns each semester, according to Suarez, though she wrote that her office does not keep exact figures.
"There is a responsibility on both sides, with the common goal of coming back to school," Jennings said.
For the female student, the lack of communication translated into disinterest. "It would have been nice to have felt that someone was there," she said.
Nwoka said the difficulty of communication revealed "a lack of transparency about who's making the decisions."
For now, Nwoka is at home in Washington. The female student plans to graduate in May.