Context & Reasoning

1. Designate a staff member as an advocate for students considering, on, or returning from a medical withdrawal.

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Issue

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Leaving Yale in the midst of a mental health crisis is a logistically complicated process involving many unrelated departments at Yale and beyond. Yale offers no effective centralized system to support students through this technically complex, financially formidable, and emotionally taxing process. 

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A primary point of contact for these students is their residential college dean; however, students in different colleges have long reported highly variable experiences with their deans with respect to both their levels of concern and their awareness of resources. While some deans reach out regularly to students on or returning from withdrawal, others offer little to no support. Ultimately, it is unrealistic to expect residential college deans to serve this specialized role.

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6/12/22: Consider Duke's Time Away Office as a wonderful example of a strongly integrated program for all students taking time off for any reason. 

 

Proposed change

 

Yale will designate a staff member in the disability advocacy sphere to serve as an official advocate for any student considering or involved in the medical withdrawal and reinstatement process. This role will not be under the oversight of the Yale College Dean’s Office, the Committee on Reinstatement, or Yale Health in order to avoid conflicts of interest (i.e. minimal liability versus the student's best interest).

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The advocate will have expertise on matters such as pathways for withdrawal and reinstatement, voluntary versus involuntary withdrawal and implications of each, student rights under the Americans with Disabilities Act and HIPAA (medical privacy act), off-campus mental health resources (e.g. therapists, psychiatrists, and intensive outpatient programs not affiliated with Yale), tuition insurance policies, and health insurance policies including Medicaid and other non-Yale insurance options. 

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2. Reform the protocol for involuntary medical withdrawals.

 

Issue

 

Yale’s current policy is that, based on information from Yale Mental Health & Counseling, the Dean of Yale College can make the unilateral decision to impose an involuntary medical withdrawal on a student. 

 

This policy does not specify how the Dean of Yale College evaluates the level of risk, or the availability of reasonable accommodations to mitigate risk and improve academic functionality. It also does not require that the Yale College Dean’s Office obtain permission to receive the student’s private health information, nor does it stipulate any checks or protections against violation of privacy. The student is denied any input into the decision-making process apart from a possible appeal.

 

Proposed change​​

 

Any involuntary medical withdrawal will be preceded by a comprehensive review process that actively involves the affected student, Yale Student Accessibility Services (the office of disabilities), and any clinical treatment providers involved in care of the student. Administrators outside the Yale Mental Health & Counseling system will not have access to a student's health information without the student’s written consent. In addition, the student will have the option to designate an advocate (e.g., an outside medical provider, faculty member, parent, attorney, or disability accommodations specialist) who participates in the decision-making process.   

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3. Restructure the refund schedule for tuition, room, and board fees.

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Issue

 

If a Yale student withdraws, they can receive:

• 100% refund of fees for withdrawals within the first tenth of the term

• 50% refund for withdrawals after the first tenth of the term but within the first quarter of the term (a $19,437.50 loss)

• 25% refund for withdrawals in the second quarter of the term (a $29,156.25 loss)

• 0% refund after midterm (a $38,875 loss). 

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The inclusive fee for resident undergraduates for the academic year 2021-2022 is $38,875 per semester. As a result, waiting one extra day to initiate a withdrawal could cost a student a five-figure amount. Students considering a voluntary medical withdrawal report feeling immense pressure around each deadline for a certain rebate tier.

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Source: Yale Undergraduate Regulations 2021-2022: Financial Services

 

Proposed change

 

Yale will restructure its refund schedule. Refunds will be decremented by 10% weekly, as at schools like Columbia. Students who are struggling at the end of a term will be reminded of tuition insurance options prior to the start of the following term.

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4. Offer an affordable PPO option of university health insurance to both enrolled and medically withdrawn students so they can see non-Yale providers in the New Haven area and beyond.

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Issue

 

Yale students have long struggled with protracted wait times for receiving therapy, insufficient cultural competency and diversity among clinicians, and infrequent and brief sessions, among other shortcomings of Yale Mental Health and Counseling. The stresses of the COVID-19 pandemic combined with pre-existing trends have led to a record surge in demand for mental healthcare at Yale. At the moment, Yale Mental Health and Counseling is attempting to serve 1,000 students a week. They have, to their credit, hired additional clinicians and "Wellness Specialists" in an effort to catch up.  However, these additions are still not nearly enough to meet demand, and university healthcare systems are simply not designed to handle issues of this scale. Moreover, with the availability of private clinics and virtual therapy and psychiatry services, this problem is solvable.

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Proposed solution

 

Yale will follow the lead of every other Ivy League institution (Harvard, Princeton, Columbia, Brown, Dartmouth, UPenn, and Cornell), as well as the entire UC system, in offering an affordable PPO insurance option. This gives students the flexibility of seeking mental healthcare at off-campus locations nationwide or through telehealth, whether they are currently enrolled or taking time off.

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5. Implement annual Mental Health First Aid (MHFA) training for students, faculty, staff, and administrators.

 

Issue

 

College-aged adults are naturally a vulnerable population when it comes to mental health. The entire campus community needs tools to respond to a mental health crisis, whether they are experiencing it themselves or having concerns about a friend or roommate. Yale has mandatory and free student programming around safe drinking habits, sexual health, bystander intervention, and more. However, Yale's MHFA course is costly and hard to access.

 

Proposed change

 

Yale will provide its MHFA course for free to the entire campus community, following the lead of schools like the University of North Carolina and University of California Santa Cruz. For incoming students, this will be a required part of First-Year/Transfer Orientation programming. Every member of the campus community can attain a working knowledge of counseling and wellness resources on and off campus, various types of mental illness, how to discern warning signs of a student experiencing mental illness, and what to do in crisis situations.

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6. Eliminate costly, non-medical roadblocks to reinstatement to Yale College following a medical withdrawal.

 

Issue

 

Students wishing to return from a medical withdrawal related to mental illness face a complex and costly reinstatement process. The required components to be considered for reinstatement include:

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• Completed coursework from a four-year college or university with grades of A or B in two term courses. This is at the student’s expense, and the cost for the two courses typically falls in the range of $2,000-$7,000. Withdrawn students may have few or no options to satisfy this requirement near their home, or only very expensive options, unless they pay to live elsewhere. Community college courses are specifically excluded. 

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• Two interviews, typically required to occur in-person and on-campus at student’s expense for travel (with current pandemic exception). 

  • Interview with the Chief of Mental Health and Counseling 

  • Interview with the Chair of the Reinstatement Committee (an administrator at the Yale College Dean’s office who is neither a medical professional nor the student’s residential college dean) 

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• Three letters of support

  • Two letters from instructors, employers, or other professionals​

  • One letter from the student’s healthcare provider (i.e. therapist or psychiatrist)

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• An application form and personal statement 

Update: In April 2022 the coursework requirement was eliminated for students who have been away for fewer than four terms. The requirement to interview with a representative of the reinstatement committee was also eliminated. In January 2023 the requirement for non-clinical letters of support was eliminated. 

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Proposed change

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These students were already accepted to Yale. Reinstatement will be solely contingent on the student adequately addressing the medical condition that necessitated withdrawal. Accordingly, recommendation letters from non-medical professionals, evaluative interviews with non-medical administrators, and academic transcripts from a four-year college or university will be eliminated from the reinstatement application requirements. This will bring Yale in line with standard practices at Stanford, Columbia, NYU, CalTech, and the University of Chicago, among others.

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​7. End the practice of rejecting reinstatement applications without actionable explanation.

 

Issue 

 

When Yale’s Committee on Reinstatement rejects a student’s reinstatement application, it does not necessarily offer a concrete, actionable reason for the decision. The Committee on Reinstatement has not published a set of clear criteria for their decisions. This practice likely violates Title III of the Americans with Disabilities Act, as Brown University's recent settlement with the Department of Justice suggests.

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Proposed change

 

Yale will publish:

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• Objective criteria for reinstatement

• Statistics on the number of approved reinstatement applications relative to the total submitted applications, updated annually

• The names and credentials of all individuals serving on the Committee on Reinstatement  

 

Yale will provide detailed and actionable feedback, citing the best available objective medical evidence, to any student whose request for reinstatement is denied.

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Update Jan 2023: Yale will give a written explanation for rejection including recommended steps for future success.

From Yale College Programs of Study (Jan 2023): 

"If a student is not cleared for return, the Committee will provide a written explanation to help the student understand the reasons behind their decision and will recommend steps the student might take to be more successful in future requests." 

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8. Stop terminating health insurance for students leaving Yale to address health conditions.

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Issue

 

Yale students who withdraw for medical or other reasons lose access to all university health insurance within 30 days. They are not even eligible for the costly Yale Affiliate insurance plan option offered to other non-enrolled students (i.e. those taking a leave of absence or studying abroad). They also do not receive a refund for premiums paid for the term. 

 

Many students fully rely on Yale for their health insurance. Furthermore, many low-income students have uninsured parents or guardians, which precludes coverage through a family plan. Once Yale's health insurance is terminated, students may find themselves navigating a complicated and expensive process to find an alternative. This burden adds to the student’s existing struggles with mental illness and the process of leaving Yale.

 

Proposed change

 

Yale will offer sustained coverage through the end of the policy year in which the student withdraws without an increase in cost. Students will have the option to decline or cancel their Yale-based health insurance plan, without penalty, and receive a prorated refund of premiums if they have other means of coverage (e.g. under a family plan). At the end of the policy year, students who remain withdrawn will have the ability to purchase an extension of the plan at a similar cost. It would be reasonable to have this option available for a maximum of two consecutive policy years.

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Update Jan 2023: Yale will offer health insurance with several caveats for students on medical leave of absence (formerly known as medical withdrawal). There is no guarantee of financial assistance, nor is there any pro-rated refund for Yale Hospitalization/Specialty Coverage premiums already paid. 

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From Yale College Programs of Study, Jan 2023: 

"Health coverage: Students going onto a medical leave of absence who are already enrolled in the Yale Health Hospitalization/Specialty Coverage have the option to enroll in the Yale Health Affiliate Coverage for Students for one year. This enrollment is not automatic. Students are responsible for completing and submitting the appropriate enrollment forms and full payment to Member Services within 30 days of going on leave. Some financial support may be available for students whose YHH/SC plan was covered by their financial aid. Application forms and details about medical coverage while on a medical leave of absence may be obtained from the Member Services Department of Yale Health."

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9. Reduce the minimum duration for medical withdrawals.

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Issue

 

A Yale student taking a medical withdrawal must remain away at least one full term—not including the term in which the withdrawal occurred—before returning. Accordingly, if a student withdraws in February, the earliest possible time of return is January of the following year, even if the student has addressed their health issues and satisfied all reinstatement requirements sooner. Similarly, if a student withdraws in September, the earliest possible time of return is August of the following year.  An unnecessarily long absence from Yale stifles a student’s recovery, as they remain socially isolated and face greater re-assimilation challenges. Moreover, this practice likely violates Title III of the Americans with Disabilities Act, as Brown University's recent settlement with the Department of Justice suggests.

 

Proposed change

 

Yale will reduce the minimum duration for medical withdrawals to the amount of time remaining in the semester when the withdrawal occurs. Additional time can, of course, be taken if the student or treating clinician determines that it is needed. This change will bring Yale in line with modernized practices at schools like Cornell.

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Update January 2023: Yale now allows an individualized assessment of time to return. 

From Yale College Programs of Study, Jan 2023: 

"Duration of Medical Leaves of Absence: The recommendation for the length of the leave will be individualized and based on a clinical assessment. Students may remain on a medical leave of absence for as long as they wish. Students may also request to return early, before the recommended date, or choose to extend their leave beyond the initial recommendation. Yale students typically remain away for at least one full term, not including the term in which the leave occurred, before returning to Yale College, but this length will vary based on individual circumstances. The medical leave is intended to allow students to achieve the level of sustained stability needed to support a successful return, and students are encouraged to take the time they need." 

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10. Allow students reasonable access to campus while on medical withdrawal.

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Issue

 

Yale students on withdrawal are banned from residences on campus, participation in extracurricular activities, and access to all university facilities. In fact, they may only traverse the campus after securing permission from their residential college dean or the Dean of Student Affairs. This policy applies regardless of whether the withdrawal is voluntary or involuntary, and regardless of whether there are any disciplinary issues involved.

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Proposed change

 

Students on voluntary medical withdrawal will be able to access libraries, athletic facilities, and all other campus spaces that would normally be open to a guest of an enrolled student or to a member of the general public. Yale will make an individualized assessment for students on involuntary medical withdrawal. In accordance with the Fair Housing Act and a 2018 settlement of students versus Stanford University, any Yale student on medical withdrawal who needs Yale Health services as part of their treatment plan will be able to petition to remain in on-campus housing, and they will be granted uninterrupted access to all necessary health care. Students on medical withdrawal will also retain access to advising resources at the Office of Career Strategy.

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Update January 2023: Yale now allows access to campus for students on time away following same policies as apply to a guest or visitor.

From Yale College Programs of Study, Jan 2023: 

"Campus Access: Students on medical leave may be present on Yale’s campus as guests or visitors and must follow all relevant university policies as such. Students living in on-campus housing at the time of a medical leave of absence are expected to move out within a few days, usually within 72 hours. If invited as a guest in the dorms by other students, they must abide by the three-day limit. See “Guests” under “Conduct in the Dormitories” in the Yale College Undergraduate Regulations. Students on leave may usually participate in undergraduate activities and registered student organizations as a guest but may not hold leadership positions or participate in university sponsored or funded international travel."

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