This story is the last in a three-part series about mental health at Brown and students’ attempts to navigate the gaps in treatment and understanding.
During any given semester, between 150 and 200 students may be on a leave of absence from Brown. Denise Ramirez ’17.5 was once one of those students.
Ramirez had been depressed throughout high school, but she was able to conceal her mental illness under the cover of good grades and participation in extracurriculars.
Yet despite attempts to suppress her depression, it always returned, sometimes with such speed that she felt as if she were drowning in it.
During her freshman year at Brown, Ramirez started feeling anxious when entering lecture halls. She felt an impulse to start screaming obscenities in front of the class, and she was afraid that one day, she would not be able to prevent those words from spilling out.
“My grades went down. I had a hard time concentrating,” Ramirez recounted. “I told myself, ‘This is normal.’”
She made it through her first year without any major incidents but did not last long into the second. Two nights in, she had a panic attack. Her roommate, unsure of what to do, called Emergency Medical Services, which quickly discerned that Ramirez was having thoughts of self-harm. The emergency medical technicians called the Department of Public Safety to escort Ramirez to Butler Hospital, where she remained for the next two weeks.
“It was there that they told me I couldn’t come back to school,” Ramirez said.
Directly after being discharged, Ramirez was taken to the office of Mary Greineder, assistant dean of Student Support Services. There she signed a few sheets of paperwork and was told that she had the rest of the night to pack. She would then no longer be allowed on campus.
Students on medical leave are often left wondering why they were put on leave and what actions they can take to be readmitted. With the growing rate of students facing mental health issues, the University has been challenged to find a balance that ensures students take sufficient time for treatment, while also setting them on a path to return to Brown.
A mutual decision?
Title II of the Civil Rights Act mandates that a student cannot be placed on leave because they are a risk to themselves, said Maria Suarez, associate dean and director of Student Support Services, insisting that all leaves of absence are taken voluntarily.
Yet many students who have taken a leave said they felt as though the Office of Student Life forced it on them.
When a student is hospitalized for mental health reasons, the University is notified of the situation within 12 to 24 hours. It then contacts the student’s parents and remains in touch with the student, Suarez said.
Once a student is discharged, the University conducts a post-hospitalization assessment, which gauges academic and social preparedness and includes an evaluation by Counseling and Psychological Services, she said.
“If someone goes to the hospital, it’s definitely not a foregone conclusion that they are going on medical leave,” said Sherri Nelson, director of CAPS.
The assigned CAPS counselor engages the student and the student’s health providers in a conversation about the appropriateness of a medical leave. Should the student end up on leave, CAPS records a baseline evaluation of the student’s mental health to which it can refer when the student applies for readmittance. The student is also required to meet with a dean and sign paperwork that formalizes the decision.
Yet, in conversations with The Herald, some students said they never received a CAPS evaluation or signed any paperwork.
Dave, a former Brown student who shared his story in a June Buzzfeed article, said he was put on medical leave while still in the hospital.
Dave’s hospitalization followed two DPS visits to his room in as many weeks — once to break up a fight between Dave and a former girlfriend and again because he had passed out in front of his door. On the night of his hospital admittance, which marked DPS’ third visit, Dave had posted a Facebook status, revealing that he had battled clinical depression for several years and that he planned to kill himself.
Once discharged from the hospital two weeks later, Dave’s dad arrived at Brown to tell him he had been put on a medical leave of absence and that they were to return home together. Dave did not hear anything from the University, he told The Herald.
Though Suarez could not discuss any specific student cases due to privacy laws, she said, “It is rare to unheard of that the student has not been met with by a dean and been provided with the dean’s recommendations and concerns. At the end of the day, it has to be the student that is being informed and is in agreement with the leave of absence.”
Dave also said he was not asked to sign any forms.
In response to such claims, Suarez said “there are cases that have extenuating circumstances” that she could not discuss.
“It is extremely rare that a student is required to take a leave of absence,” she said. “If they are so disruptive … that we feel that they can be a danger to our community, we take that into consideration.”
The University may ask whether the student is able to continue living in the same dorm with the same roommate.
Suarez said students sometimes come forward following a friend’s hospitalization and say the issues had forced them to “babysit” the student for weeks before the problem escalated.
OSL may refer students to Student and Employee Accessibility Services to provide them with accommodations before recommending that they take leave. SEAS may move students to housing in a quiet area or a single if they want to be removed from the “hectic nature of living in a dorm,” said Catherine Axe ’87, director of SEAS.
SEAS may also approve students to receive accommodations such as extensions or quiet testing areas in order to alleviate academic anxiety, Axe said.
Several students said the accommodations from SEAS had been helpful, both before taking a leave and when returning from one. But Daniel Crowell ’16.5, who took a leave in 2012, said the accommodations from SEAS allowed him to put off taking a leave and that he later wished he had taken one sooner in order to save his grades.
What is lost
Though most students interviewed by The Herald said they did not feel forced into taking a leave of absence, several indicated that they did not fully understand what they would lose in taking one: for some, their academic credit; for others, tuition; and for many, both.
When Michelle Miller ’18.5 took a leave of absence late in her first semester, she still felt confident that she would be able to finish her coursework during her leave. Miller said Assistant Dean of Student Life Ashley Ferranti told her that students on leave had taken incompletes in the past. Miller was determined to do the same.
“Ferranti gave me the hope that I would not lose everything that I’d done that semester,” Miller said.
Yet, when finalizing her leave of absence with a different dean, she was told that despite receiving permission from three faculty members to take incompletes, she would not be able to do so or else she would be put on academic warning. Though she only needed to complete one final and a few labs, Miller’s transcript was wiped clean, and she was not able to get any refund on her tuition, she said.
Miller, who was readmitted this fall, now feels pressure to take on an increased course load so she can finish her requirements within eight semesters. “My parents are reaching their 60s. They have to worry about retirement,” she said. “A fifth year is not an option for me.”
The financial pressure has left Miller worried about the possibility of taking more time off in the event of an emergency. “If I have to go home again, I won’t be able to come back,” she said.
While the University provides a tuition insurance option, students interviewed said they had not considered purchasing it.
“No one anticipates they are going to take a leave of absence,” Crowell said.
To make up for the lost time at Brown, students can take classes at other universities while on leave, but these credits may not transfer over perfectly.
“I had several administrators fight for me,” said Lena Bohman ’18, who took a leave during the year between transferring from Boston University to Brown. In transitioning into Brown, she has found the OSL and SEAS to be a powerful agent on her side.
Lingering on leave
Once on leave, Ramirez realized that she had time — lots of it.
Early on, she received intensive outpatient therapy three times per week from a local hospital. After that, Ramirez began using her time to focus more on personal growth.
She volunteered at a botanical garden. She interned with Greenpeace. She took courses at City College of San Francisco. In the meantime, she also worked closely with a therapist with whom she had been connected through the hospital.
After one semester away, she applied to come back during the spring of what would have been her sophomore year. She was denied.
The Office of Student Life’s website states that a medical leave is expected to last two full semesters, in addition to winter and summer breaks. To be readmitted, students must submit a personal statement and letters from a therapist and physician by Oct. 15 for readmission in January or by Feb. 1 for readmission in September, Suarez said. These dates were moved up this year in order to give students time to participate in the housing lottery or to enroll in summer courses.
A multi-disciplinary committee — comprising 12 to 14 members of offices such as CAPS, OSL, SEAS and the Office of the Dean of the College — come together to review the application materials, Suarez said.
CAPS looks “to see where the (health care) provider thinks the student is in terms of whether or not they are ready to return,” Nelson said, adding that the University looks for a period of “sustained stability.”
“We don’t want someone to come back to the University and then leave a month later,” Nelson said. “We want students to have gained insight into what happened during their medical leave.”
CAPS also wants to see that students have developed coping strategies, she added.
In recent years, the University has grown increasingly diligent in ensuring that students are ready to come back to Brown, given its history of readmitting students too soon, only to have them relapse.
Several years ago, Suarez decided to trust a few students who wrote her saying that they were ready and granted them readmission to Brown.
“That semester sticks in my mind,” she said. “There were three to four students who said they were ready, and within two weeks, all of them were back in the hospital.”
“Our goal for all students is that they have the ability and degree of health to live autonomously,” Suarez said.
This may require students to reapply multiple times before the University greenlights their return.
After reapplying a second time — six months after her first attempt — Ramirez was readmitted. But during the summer prior to her return, she had a relapse. The University rescinded her admittance, and she was put back on leave.
After a semester of improved healing in which she took art classes and found a part-time job, Ramirez reapplied a third time. She was denied. In a letter to Ramirez, Suarez wrote that Ramirez had not achieved a long enough period of “sustained stability.”
University rejection letters to students on medical leave list expectations the students must meet before they can reapply again, Suarez said. She added that students may appeal their denial if they feel that the University does not have enough information.
So Ramirez did just that. By attaching additional letters from herself, her therapist, an academic mentor and her sister, Ramirez was able to convince the University to grant her readmission.
Dave — who recently sent in his fifth readmittance application, this time for spring 2016 — has not had the same success. Again, he was denied.
In November, the University expelled Dave for enrolling as a degree-seeking student at another Ivy League college. A week earlier, he had been expelled from that same college for failing to list Brown among his previous education on the transfer student Common Application.
Dave said there were “only three spots for listing schools,” and he chose to put down Northwestern University, where he was a full-time, non-degree-seeking student, as well as the University of California at Berkeley, where he took classes part time, and Columbia, where he was enrolled prior to Brown.
Dave is currently living at home in the Bay Area, pursuing litigation against both Brown and the school he most recently attended. He filed a complaint against Brown with the U.S. Department of Education’s Office for Civil Rights last May. The Department of Education declined to comment on specific cases.
Several students said a lack of communication from administrators and the opacity surrounding reapplication materials added to the difficulty of gaining readmittance.
“They forgot about me pretty much,” Bohman said. She said she tried calling the University four times to get in touch with Suarez, who did not return her calls, but was finally connected with a secretary who helped her find the necessary paperwork.
For students reapplying, time is of the essence. Paperwork must be obtained from a psychologist three or four weeks ahead of the readmittance deadline, Bohman said. Without a University reminder, she did not know when she was expected to start gathering the materials for her readmittance.
“There doesn’t need to be hand-holding,” she said. “It just needs to be clear.”
Other students, like Crowell, said the reapplication process went smoothly once he felt ready to return but said he wished the University had checked in more with him over the course of his leave.
Suarez said the University attempts to clarify the readmittance policy for students from the moment they leave campus. Students are given copies of the leave of absence forms, which note the readmittance deadlines at the bottom, as soon as they sign them, she added.
“This is a lot of information, and we understand that,” she said.
Historically, OSL also sends students a second copy straight to their home addresses. The forms are also available online.
In fall 2014, Student Support Services received the funding needed to hire a fourth associate or assistant dean, allowing the office to be fully staffed for the first time and finally able to start reaching out to students on leave at least once a semester, Suarez said.
Miller applied for readmittance last winter and was happy with the University’s improved communication. “They sent out emails about the deadline. They were good at informing me about what I needed to do in order to get back,” she said.
But some students said they want more than just a brief check-in. They also want advice about how to make the most of their leave.
“I wish I’d had more of a plan when I left,” Crowell said. “I didn’t know what I was doing. A lot of that time seems wasted.”
Readjusting upon return
If reapplying was not turbulent enough, students may return to a Brown vastly different from the one they left.
Crowell’s medical leave lasted three years. In the time he had been gone, most of his friends had graduated. “It was a challenge coming back,” he said.
Other returning students encountered similar struggles. Ramirez, who was gone for three semesters, said she felt like her friendships changed drastically within that time.
No longer in the same class year as Ramirez, many of her friends from her first year had stopped talking to her.
“I felt lonely to begin with,” Ramirez said. “It was a little bit harsh, feeling so alone.”
Determined to make the most of being back at Brown, Ramirez became a part of North House, a vegetarian co-op. The house’s nightly group dinners helped her get to know new people quickly.
She also attended meetings of the Back at Brown group, led by Linda Welsh, a psychotherapist at CAPS.
The support group unites people who are in their first and second semesters returning from leave in a conversation about coping strategies and their transitions back to campus, Welsh said.
Returning students must also balance their readjustment to a new social scene with the rigor of academics, she added.
Though Ramirez started out with a full course load during her first semester back, she later decided, with the help of SEAS, to drop from four classes to three.
Bohman, though, said she found it “easier to return to schoolwork than (she) expected.”
“It was like riding a bike — I hadn’t forgotten,” she said.
Still, students may be anxious about returning to Brown after leaving during an emotionally difficult time, Welsh said.
“I still had a little bit of resentment toward the administration, and that was always in the back of my mind,” Ramirez said.
Yet the University has a vested interest in making sure students are comfortable in their return. The OSL reaches out to students when they come back to talk to them about their transition.
Though some students were originally upset, and even confused, about their medical leaves, many found that the time allowed them to heal and practice self-care.
“Students may change what their goals are, academically or career-wise, after having been out for a few semesters,” Welsh said. “In coming back, they get to know themselves and the directions for their future a bit better.”