The years-long quest for mental health care reform
The past four years have been marked by a continuous tension between student advocacy for improved mental health services and University attempts at resolution via policy change.
When students were sent home in March 2020 due to the COVID-19 pandemic, debates over the efficacy of Yale’s mental health policy reignited, with students demanding better services and increased accessibility.
The years since have seen numerous attempts by the University to respond to student calls for change — including the expansion of Yale Mental Health and Counseling staff, the implementation of the Yale College Community Care program and the reformation of the medical leave policy.
Such changes have been met with mixed feedback. In particular, the policies for medical leave — a process previously known as withdrawal, where students take time off from Yale due to mental health concerns — have long remained a source of student ire.
The issue came to a head this past December when a group of alumni and undergraduate students filed a class-action lawsuit against the University, alleging discrimination against students with mental illness. Since the lawsuit, the University has announced momentous changes to the medical leave policies, and the plaintiffs are in settlement negotiations with the University.
Mental health during the pandemic
Immediately following the outbreak of the pandemic, the University was forced to cancel or postpone many mental health services, according to Paul Hoffman, director of Yale Mental Health and Counseling.
In the following weeks, the University switched to a virtual counseling model that required students to meet with their MHC therapists virtually, with Yale covering the costs. This model was extended to students in 43 states with relaxed guidelines for counseling across state lines. Students in the remaining seven states were referred by Yale Health to mental health counselors in their home states, though the University covered expenses.
Still, after a long gap in in-person treatment, many students found it difficult to reconnect with their Yale-provided therapists.
Scott Gigante GRD ’21 spoke to the News in 2020, explaining how losing contact with his therapist exacerbated his mental health problems.
“One of the consequences of having untreated mental health issues is it’s often hard to take the initiative to reboot mental health treatment when one is not receiving treatment,” Gigante said. “As somebody who has benefited a lot from regular mental health treatment, losing that at a time when mental health became more difficult certainly made an already difficult time worse.”
In August 2020, in response to these issues, Students Unite Now — a student organization dedicated to improving financial aid transparency and mental health care accessibility at Yale — released a report claiming MHC had failed to address increased student needs brought about by the pandemic.
The report specifically criticized the high student-to-counselor ratio and the unreasonably long wait times students faced when trying to schedule an appointment.
“I think people wait until they absolutely need it or absolutely can’t continue the way that they’re continuing to reach out for help. People don’t ask for help until they really have reached the end of their rope,” said Becca Rubright ’22. “Then to be told, ‘we can’t see you for a month or two months’ can be pretty disheartening. Why does it take like four weeks to get an appointment at a center that’s supposedly for student health?
Rising wait times and advocacy
Throughout 2021, Yale saw a record increase in the number of students seeking mental health support. Over 500 more students used MHC services during that year than in the year prior, and 70 percent more students sought treatment at MHC in 2021 than five years prior.
At the time, Hoffman attributed long wait times at MHC to the high volume of students seeking treatment. He acknowledged that long wait times can be “discouraging” and said the University was working to decrease them.
“Yale is not unique in this; college student’s mental health utilization has increased across the country and I expect the pandemic will only add to this trend,” Hoffman wrote to the News in March 2021. “I would encourage any student worried about wait times to reach out [to Yale Mental Health and Counseling], students with urgent situations can receive treatment very quickly and for many it can have a profound effect on their well-being at Yale.”
In the spring of 2021, advocacy groups including SUN, the Yale Mental Health Association and the Yale College Council continued to voice the need for reform in mental health policy. In addition, the student group Disability Empowerment for Yale pushed for the expansion of Student Accessibility Services to accommodate concerns of students with mental health challenges.
A number of new organizations also emerged to advocate for reformed mental health policy. The Mental Health Justice at Yale Coalition — which formed in spring 2021 — pushed for large increases in the number of clinicians employed by MHC. Students and alumni also founded the mental health advocacy group Elis for Rachael, which is involved in the recent lawsuit against the University.
“People who aren’t familiar with serious psychiatric illness may not realize [that mental health on campus] is not run-of-the-mill anxiety,” Paul Mange Johansen ’88, one of the leaders of Elis for Rachael, said. “These are potentially life-threatening problems that need equally serious solutions. And I feel like there’s been no effort to really take this as seriously as it deserves to be and needs to be taken.”
Amid this increased advocacy work, Hoffman and then Dean of Yale College Marvin Chun announced two major expansions to the University’s mental health care policy in April 2021.
The first expansion was the establishment of the Yale College Community Care program, or YC3, an effort to provide increased and varied resources for mental health care by providing clinicians and wellness specialists through the Yale College Dean’s Office.
Staff members include four college care clinicians — licensed social workers and psychologists — available for drop-in support as well as four unlicensed community wellness specialists. Each of the eight staff members have offices in the residential colleges, rather than in Yale Health — yet, the therapists are still associated with MHC.
“All eight YC3 clinicians and specialists expand the types and settings for mental health support and make it easier and faster for you to get counseling,” Chun and Hoffman wrote in an April 2021 email to the student body. “You can turn to any of them, even if you are unsure which option is best for you. Along with their own services, the YC3 staff will provide a pathway if you are thinking about pursuing more formal, ongoing therapy through Mental Health and Counseling.”
The second expansion included in the April 2021 announcement was the addition of six new full-time licensed clinicians to MHC’s main location in Yale Health. In total, the announcement brought 10 new licensed therapists to the University.
However, students continued to voice concerns following these changes, still claiming that the changes did not sufficiently decrease wait times or provide transparency in how to access care through MHC.
In early November 2021, Hoffman announced that MHC would add a temporary second location on Whitney Avenue, in addition to its primary location at Yale Health.
Medical leave policy
The policy for going on leave and returning to campus has long remained at the center of mental health advocacy, as policies in the past have often made it difficult for students who take time off from Yale to receive support from the University.
In previous years, the reinstatement process required students to complete interviews and two term courses. However, in April 2022, the University quietly relaxed its reinstatement policy, the first alteration to the plan since 2016, making it easier for students who withdraw mid-semester to re-enroll at Yale.
Yet, in November of last year, pressures for mental health care reform at Yale pushed from beyond campus, when the Washington Post published a story criticizing the University’s withdrawal and reinstatement policies for students struggling with mental health.
Four days later, Hoffman and Dean of Yale College Pericles Lewis responded to the article in an open letter published in the Washington Post. University President Peter Salovey also gave a statement. All three administrators defended the University’s mental health care policy.
“[The Washington Post story] perpetuated a dangerous belief that college students should stay in school whatever the risk to their mental health and safety,” Lewis and Hoffman wrote in the letter. “We know firsthand the heartbreaking circumstances that surround mental health crises — including, sometimes, the need for students to take a break from their studies so they can focus on their health.”
Just weeks later, members of Elis for Rachael and two undergraduate students filed a class action lawsuit against the University, alleging that Yale does not successfully accommodate and support students who struggle with mental illness.
The suit accused Yale of discriminating against students with mental illness, specifically citing that it is more difficult for students who withdraw due to mental health challenges to be reinstated. The plaintiffs hoped to earn policy reform, rather than financial compensation, with the suit.
“Yale has ignored student demands for change for decades, doing only the bare minimum to accommodate students with mental health needs,” Alicia Abramson ’24, one of the student plaintiffs, wrote to the News. “Yale has refused to make substantive changes to policies that discriminate against students with mental health disabilities despite our federally protected rights to accommodations. There is no excuse for Yale’s refusal to change their punitive and disciplinary policies.”
One week after the suit was filed, Yale administration and the plaintiffs moved to halt proceedings and work toward a settlement. A month later, amid settlement negotiations, the University announced sweeping changes to its leave of absence policies.
Medical withdrawals were renamed and reclassified as medical leaves of absence. Additionally, reinstatement requirements were relaxed for students who step away from campus due to mental health concerns.
Previously, students who wished to take time off after the second week of the semester for mental health reasons were forced to file for “medical withdrawal,” a process that limited student access to many University resources — including insurance coverage — and required students to reapply before they could return.
The reclassification of a medical withdrawal to a medical leave of absence allows a student struggling with their mental health to take leave and retain Yale insurance, take summer classes and visit campus.
The changes also removed a minimum time for taking a medical leave of absence and allowed students to take as few as two classes per semester in the case of an extreme crisis.
“Our primary goal is to reduce the obstacle for students getting the care that they need,” Lewis told the News, “This presumably will mean that it’s somewhat easier for a student to make the decision to take a leave if they feel that they need it and also that they know that it’s not a complicated process to come back after such a leave.”
Despite acknowledging that these changes are a “step in the right direction,” plaintiffs are still concerned about the quality of mental health care at Yale and remain in negotiations with the administration.
Specifically, plaintiffs criticize the requirement of students taking a reduced course load to pay full tuition and the codification of the University’s practice of forcing students to take involuntary leaves of absence.
Following the changes, students have also continued to advocate for change.
Last month, SUN held a rally on Beinecke Plaza that included calls for mental health reform. At the rally, students shared their personal stories to demonstrate the issues they saw in Yale’s mental health system.
“I take this issue very seriously,” Craig Birckhead-Morton ’24, a speaker at the rally, said. “Since this experience, there have been two suicides at Yale, both people I’ve personally known. This issue of mental health care is really a matter of life and death.”
Yale Mental Health and Counseling was founded in 1925.