In her sophomore year at Yale, Naasiha Siddiqui ’07 found herself facing more problems than just the sophomore slump. Siddiqui was severely depressed, and when she checked into the Mental Hygiene Department at University Health Services, she was forced to leave school on medical withdrawal. Ever since, she has struggled to balance manic depression with a college career — taking three forced withdrawals and one voluntary leave of absence, and applying for readmission five times.

“I was really frustrated,” she said, referring to her first forced withdrawal in the fall of 2001. “Their attitude was, ‘She’s unstable, we don’t want her at school right now.’ In one respect, it seemed like discrimination because I was doing all I could to try to stay in school. But on the other hand, the administration should have some say over when students aren’t fit to go to school.”

Mental illness has long been a hot-button issue on college campuses, but in the wake of this month’s shootings at Virginia Tech, even greater scrutiny has been placed on university support systems for students with psychological illnesses. At Yale, the Mental Hygiene Department specializes in counseling and crisis intervention for suicide and depression cases. But in seeking to protect the psychological health of its students, Yale’s mental health services must walk the fine line between enabling students to receive treatment while remaining in school and protecting the student’s health and safety — or the health and safety of others — by sending seriously depressed students off campus.

For the most part, universities across the country find themselves in a sticky situation with regard to mentally ill students. Universities may be found liable if they fail to detect and respond to cases that result in suicide or murder. But privacy and anti-discrimination laws limit the amount of information about students’ mental health to which administrators have access, and the laws may prevent administrators from forcing students to take involuntary medical leaves.

In general, the laws forbid universities from disclosing information about a student’s health records to parents or administrators, including residential college deans and masters, without the student’s consent. The exception comes when health officials believe that the health and safety of the student or of others are at risk. But Yale administrators said the definition of such an emergency is often blurry.

Because of the subjectivity of such cases, the decision whether or not to force a student to withdraw is made on a case-by-case basis, YUHS Chief Psychiatrist Lorraine Siggins said.

“Most students who take a medical withdrawal ask for it themselves,” Siggins said. “However, occasionally a student who had attempted suicide and is considered to be a danger to self and others is asked to take time away from school for treatment and to get their mental health issues stabilized.”

According to University policy, if a student is forced to withdraw for mental health reasons, he or she may not reapply until two semesters have passed, including the one during which he or she left. With such serious consequences, administrators said, withdrawal cannot be forced simply based on strange behavior or a possible diagnosis of mental illness, Siggins said.

Yale officials said the forced withdrawal policy serves the best interests of vulnerable and potentially reckless students. When students are severely mentally unstable, Siggins said, they can lack the presence of mind to voluntarily seek the medical help and time away from campus that they need to resolve health issues.

But Siggins said students are expected, as dictated by University regulations, to return to school as soon as doctors confirm that they have recovered.

The YUHS Mental Hygiene Department seeks to address mental health problems before they reach the point of necessitating a forced withdrawal. It offers mental health and counseling services to all enrolled students throughout the year, Siggins said, and because mental health issues can be dangerous and pressing, the department makes a concerted effort to be easily accessible, providing an on-duty psychiatrist 24 hours a day.

“In the course of an academic year, we see between 16 percent and 20 percent of the student body,” Siggins said. “For students who have continuing mental health problems, we can provide treatment throughout the year.”

But although officials say Yale’s mental health counseling program focuses on reaching students before they reach a crisis point, Yalies who have gone through counseling at the Mental Hygiene Department said that Yale could do a better job of removing barriers to getting help.

Susan* voluntarily entered the counseling program at YUHS during the first semester of her sophomore year. Although she told them she needed immediate attention for urgent anxiety and depression, she had to wait over a week before she was allowed to see a therapist, instead meeting first with a clinical social worker.

“Unless you are suicidal, they make it very difficult to see someone,” Susan said. “This is particularly scary when it comes to mental hygiene problems.”

Susan said the narrow-minded focus on suicide detection to the exclusion of other problems deterred her from using campus psychiatrists and led her to consult a therapist in a different state whom she can only visit once a month.

But she added that though it can be difficult to get an initial appointment, once a student has made an first visit to the YUHS clinic, it becomes easy to get further appointments with a therapist.

Siddiqui said the prospect of being forced to withdraw can also prevent students from going to seek help.

“Mental hygiene can be very alienating,” Siddiqui said. “Since I had my experience, a lot of my friends have been afraid to go to mental hygiene because they don’t want to get kicked out of school. It’s not a very welcoming place.”

Some students said the mental health department is too quick to act in cases of suspected depression. One student who had been referred to a YUHS psychiatrist said that fear of liability in the event of a suicide or murder makes Yale administrators move too swiftly to hospitalize or force the withdrawal of a student.

During a psychiatry session, Ryan,* a junior at Yale who has withdrawn because of his bipolar disorder, said the therapist kept asking him if he ever had suicidal thoughts, and specifically if he was drawn to sharp objects or tempted to hurt himself. Ryan said that though he ultimately was given a choice whether to withdraw, officials pressured him to do so.

While the attention to suicide might be helpful in preventing crisis situations, Ryan said, the manner in which it was addressed was unhelpful.

“I might have been suicidal, but I wasn’t looking to withdraw,” Ryan said.

Ryan said that he has seen private psychiatrists who never mentioned hospitalization, but that college doctors are more ready to hospitalize their patients because of the fear of liability in the case of a suicide.

Outside the examining rooms of health services departments, universities often find it difficult to determine when psychiatric help is warranted, since it is difficult to know when a student’s erratic behavior stems from mental illness rather than the vagaries of ordinary college life. Though Yale prides itself on providing many levels of supervision, from peers and professors to the residential college system, some students worry that this method of observation and personal counseling is not necessarily effective.

“I talked to my master and dean about my problems, but they didn’t even notice anything was wrong before I brought it up,” Susan said.

In the wake of the Virginia Tech massacre, deans and freshman counselors have discussed the protocols already in place to deal with students who may seem to have psychological problems.

Freshman counselors in Branford and Silliman said they discussed mental health risks at their weekly meetings with their deans last Monday. But their rules about watchfulness or guidance did not change in the aftermath of the shootings, counselors said.

“We talked about the incident, but we did not get any official instructions,” freshman counselor Amy Broadbent ’07 said.

Although there is no specific protocol for the freshmen counselors to follow if they become aware of a possible mental health issue, they said they are trained to talk to students who come to them with problems and to take them to see professionals at YUHS. Counselors said they deal with mental health issues on a case-by-case basis, and have confronted problems ranging from severe depression to slight anxiety over classes or relationships.

“We have liaisons in the mental health department if we have any questions or to help us navigate the bureaucracy,” said Howard Locker ’07, a freshman counselor in Silliman. “The dean did not specifically tell us to be more on the lookout [after Virginia Tech], it’s something I think most counselors are innately attuned to do in the wake of such a tragedy.”

Siggins said that although 90 percent of the students who come in for therapy do so on their own, the rest usually come to the clinic at the suggestion of their deans, coaches or friends. But she said there is no difference in the amount of attention paid to students based on how they were referred.

“We always take student peer concerns very seriously,” Siggins said. “We treat each student on an individual basis.”

*The names of some students have been changed to protect their medical information.