Adam C. Powell, Ph.D.Are they discriminatory?
Across the nation, students are being asked by universities to take medical leaves of absence due to issues with mental health, physical health, and substance use. Such leaves of absence are often justified by their potential benefits to the student, the university, or both.
While in some circumstances, leaves of absence may be mutually viewed as beneficial by the student and university, in other circumstances, students may disagree with their university’s request.
There are two potential goals of medical leaves of absence: to provide the student an opportunity to recover from an illness without being subjected to the rigors of university life, and to remove the student from the university to decrease the likelihood that the student will be a direct threat to others on campus.
Until the Department of Justice revised regulations for implementing Title II of the Americans with Disability Act (ADA) in 2011, students could be removed if they constituted a direct threat to themselves, as well as a direct threat to others.
A student’s departure from campus can have a number of financial implications for the student.
A leave of absence can create a difficult situation, as it can lead to a loss of financial aid to fund current expenses (e.g. food, housing), and also trigger the beginning of loan repayment. Individuals may not be able to recover the cost of tuition, room, and board for the semester in which they disenrolled.
The financial implications of lost tuition are so substantial that some families opt to purchase insurance against the risk. Departures also have the potential to impact an individual’s lifetime earnings, as they typically delay graduation, and may reduce the likelihood that the student ever graduates. Individuals that do not return to school may have difficulty repaying their student loan debt.
From a nonfinancial perspective, a forced leave of absence can cause hardship to a student, as it inherently removes the individual from the campus community.
Individuals on a leave of absence, if previously residential, will need to relocate and may experience a weakening in their social ties.
They likewise will need to restructure their daily schedules, and to find new forms of daily purpose, other than being a student.
The perception of this burden is so great that one Yale student cited concerns about being asked to withdraw and not allowed to return shortly before committing suicide. Such concerns, whether real or imagined, are a barrier that students face in accessing mental healthcare.
Universities, too, experience financial and nonfinancial impacts which influence their decisions to require students to take medical leaves of absence. Student absences result in a loss of tuition and ancillary revenue, although the impact may be blunted if the university has a waiting list of potential transfer students and the tuition is nonrefundable.
From a nonfinancial perspective, universities must balance the rights and interests of an unwell student with the rights and interests of the others on campus.
In the wake of the Virginia Tech shootings, in which a psychologically-troubled student murdered others on campus, the Association of American Universities released a document summarizing a safety survey that it conducted with its constituent members. The findings highlighted that universities may request students to take a voluntary medical leave of absence or a mandatory administrative withdrawal to obtain treatment.
Given the potential negative financial and nonfinancial impacts that an involuntary medical leave of absence may have on a student, a number of students have filed suits against universities claiming that their removal constituted a violation of the ADA.
The ADA defines a person with a disability as having a physical or mental impairment which limits one or more major life activities. This includes people who have a record of an impairment but who may no longer have or perceive they have an active disability. The ADA’s definition does not specify all the impairments which are covered by the law. Public schools, as well as private schools not directly operated by religious institutions, are covered by Title III of the ADA, which requires public accommodations to comply with the ADA’s nondiscrimination requirements.
Thus, the ADA applies to universities, and students placed on involuntary leave have grounds for considering their removal to be potential discrimination.
An investigation by Ronan Farrow identified 22 students at 10 schools that were placed on forced leaves of absence, and were unhappy about their departures.
Nonetheless, students placed on forced leaves are a subset of the students who take leaves of absence for mental health reasons – a population which is itself somewhat small. During the 2017-2018 school year, schools with 10,001 to 15,000 students had a mean of 27.3 students take leaves of absence (sometimes voluntarily) for psychological reasons; about a quarter of a percent of the student body.
There have been a series of lawsuits by individuals against universities, alleging that their forced leaves from their studies constituted a violation of their rights under the ADA. Plaintiffs include six students placed on medical leave at Stanford, a student at Harvard, a student at Princeton, and a student at Yale.
Although the nuances of every student’s situation differ, the Stanford students filed a class action lawsuit against the university due to the substantial overlaps between their experiences.
The class action lawsuit alleges that Stanford violated the ADA, the Fair Housing Act, and the Rehabilitation Act, in addition to California civil rights and housing laws in its actions towards the students.
The suit alleges that one student was told that he “had caused his dormmates psychological harm” and “had been a disruption to the community,” and that another student was told she had been “disruptive to her classmates and academic program and that her needs exceeded the resources the university could provide.”
In at least one instance, a student has been successful in litigating an ADA complaint. Northern Michigan University reached a settlement in 2018 with the Department of Justice over an ADA complaint that was filed in 2013.
One of the students that was a plaintiff alleges that the university threatened to disenroll her, required her to undergo a psychological assessment, and required her to sign a behavioral agreement that prohibited her from discussing her suicidal thoughts with other students.
As a consequence of the settlement, the university was required to draft an ADA non-discrimination policy, change the language on its webpage, create a training program for faculty and staff, and pay $173,500 in damages to the four students alleging discrimination.
When determining policies for forced leaves of absence, universities should consider their legal obligations towards both students with mental illnesses and towards other students on campus.
While a leave of absence can provide respite and time to recuperate, it can also be a source of financial and nonfinancial hardship. In circumstances where students are required to leave involuntarily, the student likely perceives the hardship of disenrolling to outweigh the benefits.
It is in these situations in which the student and university do not agree upon the best course of action that conflicts can arise. While universities do have obligations to protect all students, they must make sure that they do so in a non-discriminatory manner.
Adam C. Powell, Ph.D., is President of Payer+Provider Syndicate. He holds a Doctorate and Master’s degree from the Wharton School of the University of Pennsylvania, where he studied Health Care Management and Economics.
