Publisher Health

In the weeks after Rachael Shaw-Rosenbaum, a first-year student at Yale, died by suicide in 2021, a group of strangers began convening on Zoom.

Some of them knew Ms. Shaw-Rosenbaum. But many only knew what she had been going through, as she struggled with suicidal thoughts and weighed the consequences of checking herself into the hospital.

One, a physician in her early 40s, had been told years ago to withdraw from Yale while she was hospitalized after a suicide attempt, an experience she recalls as chillingly impersonal, “like you’re being processed through this big machine.”

Another, a classical pianist in his 20s, withdrew from Yale amid episodes of hypomania and depression, feeling, as he put it, “not just excluded but rejected and cut off and forgotten about.”

Members of the group, which took the name Elis for Rachael, shared a complaint that Yale’s strict policies on mental health leaves — requiring students to withdraw without a guarantee of readmission, stripping them of health insurance and excluding them from campus — had penalized students at their most vulnerable moments.

“We discovered that there were just generations of Yalies who had had similar issues, who had kept quiet about it for decades and decades,” said Dr. Alicia Floyd, the physician, one of the group’s founders. “And we all felt like something needed to change.”

The organizing that began that day culminated last month in a legal settlement that considerably eases the process of taking a medical leave of absence at Yale.

Under the new policy, students will have the option to extend their insurance coverage for a year. They will no longer be banned from campus spaces or lose their campus jobs. Returning from leave will be simpler, with weight given to the opinion of the student’s health care provider.

Most strikingly, Yale has agreed to offer part-time study as an accommodation for students in some medical emergencies, a step it had resisted.

“My hope is that the changes that have emerged from these discussions will make it easier for students to ask for support, focus on their health and well-being and take time off if they wish, knowing that they can resume their studies when they are ready,” said Pericles Lewis, the dean of Yale College, in a message to students.

Yale declined to comment beyond the statement from Dean Lewis.

Yale’s withdrawal policies were the subject of a Washington Post investigation in November 2022. The same month, Elis for Rachael filed a class-action lawsuit accusing the university of discriminating against students with disabilities.

Yale is not the only elite university to face legal challenges over its mental health policies. The Department of Justice has investigated Brown and Princeton over their handling of withdrawals, and Stanford faced a similar class-action lawsuit in 2019.

By offering part-time study as an accommodation, Yale has provided relief beyond what Stanford did, said Monica Porter Gilbert, an attorney at the Bazelon Center for Mental Health Law who represented plaintiffs in both cases.

“It’s the students and the plaintiffs in this case making their voices heard and bringing Yale to the table to have difficult conversations,” she said. The pandemic years, she added, have brought new urgency to their arguments. “As a nation, we talk about mental health differently now.”

Alicia Abramson, a Yale senior who is one of the two student plaintiffs in the class-action lawsuit, said Yale’s response was swifter and more comprehensive than she had expected. “It’s hopeful, in the sense that maybe they are finally taking this thing seriously,” she said.

She has no plans to abandon her advocacy work anytime soon, though. “I’m certainly hesitant to give Yale infinite praise,” she said. “You know, we had to sue them, right?”

A Campus Shaken

As she struggled with suicidal thoughts in the second half of her first year at Yale, Ms. Shaw-Rosenbaum worried she would be forced to withdraw, jeopardizing the scholarships she needed to stay at Yale, said Zack Dugue, her boyfriend.

She had already been hospitalized once, her first semester. “Basically, if I go to the hospital again, I will not be able to resume college and will lose the opportunity I had to learn at an extremely competitive university,” she wrote in a post on Reddit a few days before she died.

Growing up in Anchorage, Alaska, Ms. Shaw-Rosenbaum had been a debate champion. She dreamed of following her idol, Ruth Bader Ginsburg, to the Supreme Court.

Mr. Dugue, who met her at a scholarship event the spring of their senior year of high school, described her as “a tiny firebrand” and “super-duper kind.” She was still very young: Mr. Dugue was the first boy she ever kissed, her mother said.

She was not from a wealthy family; at home, she had at one time received health care through Medicaid. Withdrawing would mean losing not just her sense of belonging, but her Yale health insurance, a prospect Mr. Dugue said she found “apocalyptic.”

“She also would have lost access to the very care she needed,” he said. “That was like a terrible tightrope to walk.”

For decades, students had criticized Yale’s withdrawal and readmission policies, which were deemed among the least supportive in the Ivy League in a 2018 white paper by the Ruderman Family Foundation.

In 2015, a sophomore math major named Luchang Wang died by suicide after posting a desperate message on Facebook, saying she “couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted.”

“Yale was a case where they were being very strict, and people would have to apply multiple times,” said Marcus Hotaling, president of the Association for University and College Counseling Center Directors and director of counseling at Union College in Schenectady, N.Y.

Colleges must weigh the risks of allowing struggling students to remain on campus, he said, since they may be found liable for allowing a student’s condition to deteriorate.

Dr. Hotaling cited the case of Elizabeth Shin, a student at the Massachusetts Institute of Technology who died by suicide in 2000. Her parents, who had not been told of her decline, filed a $27 million wrongful death lawsuit against M.I.T.; the case was settled for an undisclosed amount.

Suicide contagion may be a concern for the university; so is the effect a suicide on campus may have on the larger community. “That’s going to have a drastic impact on the roommate, on the residents who live around them, their friends, their peers, their classmates,” he said.

After Ms. Shaw-Rosenbaum’s death, Yale officials took the unusual step of releasing a statement denying an allegation, circulating on social media, that Yale had refused her request to take a leave.

Undergraduate activists began demanding changes to the leave policy, as they had after previous suicides, but there was little response from Yale. “At the end of the day, we recognized we were at the mercy of the institution,” said Miriam Kopyto, who was then a leader in the Yale Student Mental Health Association.

A shift came with the involvement of alumni, who convened their first Zoom meeting just a few days after Ms. Shaw-Rosenbaum’s death. About two dozen people attended, including Mr. Dugue, and all felt some personal connection to the cause, said Lily Colby, a community organizer.

They held a moment of silence, shared pictures of Ms. Shaw-Rosenbaum and told their own stories. “We have been impacted in some way,” Ms. Colby said later, describing the core group. “We’ve had a loss or a tragedy.”

Students had tended to ask the university for accommodations on the grounds that it was the right thing to do, Ms. Colby said. The alumni began educating them on what they could demand under law — like a change to the leave policies.

For student activists, this was a fundamental shift. “Some of it is a favor,” Ms. Kopyto said. “And some of it is not.”

‘Time Away Mentors’

In January, Yale introduced major changes to its policy, reclassifying mental health breaks as leaves of absence rather than withdrawals, extending health insurance benefits and simplifying the reinstatement policy.

The settlement expands those protections by offering part-time study and creating a “Time Away Resource” for undergraduates. The court will oversee Yale’s compliance with the agreement for three years.

Lucy Kim, 22, who was among the last undergraduates to take a medical withdrawal under the old system, recalls crying when she read the news, because the accommodations were the ones that she had needed.

“I just kept thinking, if only I had gotten sick a year later,” she said.

She was a second-semester sophomore, juggling coursework in molecular biology and biochemistry and global affairs, when she stopped sleeping for 40-hour stretches. Her hands shook so violently that she dropped things. She began hallucinating.

Diagnosed with a sleep disorder, she initiated a medical withdrawal in December 2021. She had studied the policies, but was still jolted by the reality: She was given 72 hours to vacate her dormitory and surrender her key card.

“It really is like losing your house, your job and your family, all at the same time,” she said. She drained her savings, she said, spending $15,000 on rent, food and tuition for summer school classes before applying for reinstatement by submitting an essay, grades and letters of recommendation.

Ms. Kim, who will graduate next May, hopes mental health leaves will be seen differently now. This weekend, she began recruiting undergraduates to serve as “time away mentors” who help others navigate the process of taking leaves and returning to campus. She hopes that the university will provide funding.

“I think that Yale does want to move in the right direction,” she said. “It’s a matter of accumulating those voices for change until it reaches the threshold point where Yale says this is probably for the benefit of the greater student body.”

In interviews, students said the new policy opens avenues they had viewed as shut.

“What they’ve done has created an opening where I feel like I could actually go back if I wanted to,” said one former student, Jen Frantz, referring to the option of part-time study. She withdrew from Yale twice because of mental health crises, and finally let go of the idea of finishing her degree.

Ms. Frantz, 26, went on to get an M.F.A. in poetry at the Iowa Writers’ Workshop and now tutors students working on college essays. She said she felt “a little light touch of mourning of what could have been if they had been more prompt.”

As for Ms. Shaw-Rosenbaum, she was a stickler for detail. Had she lived, Mr. Dugue said, she might have sued Yale herself at some point.

“She read the withdrawal policies, she explained them to me, she was thinking about them, she knew they were wrong,” he said.

Rachael’s mother, Pamela Shaw, singled out two provisions of the settlement that she thought would have helped her daughter: part-time study and an administrator dedicated to advising on time away.

“I just wish she’d been here for the fight,” Ms. Shaw said.

Kitty Bennett, Susan Beachy and Alain Delaquérière contributed research.