Medical leaves of absence, particularly those related to mental health, have become increasingly common at colleges and universities. As leaves have increased, many institutions have faced legal scrutiny, including cases where courts or federal agencies found violations of disability laws. But medical leaves are not straightforward; they touch on student and community safety, student success, legal compliance, and institutional risk. Universities should proactively examine how they can reduce risk while better supporting students and families through this process.
Current State of Mental Health on College Campuses
According to the 2024-2025 Healthy Minds Study of 135 universities nationwide, 37% of students report moderate to severe depressive symptoms, and 32% of students report moderate to severe anxiety symptoms. Recent national data surveying provosts found that mental health was identified as the leading threat to student well-being and safety, surpassing other traditional institutional risk concerns. These findings underscore the need for coordinated prevention, intervention, and policy strategies.
Where Institutional Risk Is Found
Risk exists at every stage of the medical leave process, making the appropriate protocols and supports essential. The question institutions should be asking themselves is, "Are we supporting our students appropriately?"
Leave Request and Initial Assessment
Medical leave policies should be accessible, clearly communicated, and backed by a formalized review process. Clear procedures regarding who receives, evaluates, and responds to leave requests promote consistency and transparency across the institution. When a leave is determined to be the appropriate path, these discussions can help students understand the process, supports, and next steps.
Continuity of Care
Next, it is important to explore the ongoing clinical support that students may need. In some cases, this may involve an acute crisis response requiring the student to be connected to emergency care, while in others it may involve connecting the student with a community provider closer to home. Institutions should also clarify how treatment providers and continued care may support the student’s eventual return from medical leave. Letting students know what institutional support will be available during their time away can provide an additional layer of care while keeping confidentiality laws front of mind.
Discharge Planning and Re-entry
The return from a medical leave is a critical period. Medical leave policies should include clear return procedures, timelines, expectations, and information regarding available supports. Ensuring that mental health and other treatment providers have access to required forms and documentation early can help prevent delays or confusion during re-entry. This preparation supports appropriate assessment of treatment goals, continuity of care, and identification of additional supports needed for a successful transition back to campus. Institutions should also ensure that students are aware of disability support and accommodation processes.
Legal and Compliance Risk
Landmark cases have given universities valuable opportunities to reevaluate policy through both a student-centered and risk-conscious lens. Some common examples are:
Disability Discrimination: When students need a medical leave, it is important to emphasize that their leave should not be based on a particular mental health condition. Several well-known cases were brought under the Americans with Disabilities Act (ADA) that involve situations in which students alleged they were required to take leave based primarily on their diagnosis, rather than an individualized assessment.
Hurdles Upon the Return Process: An issue unfamiliar to many legal cases surrounding medical leaves is the student’s burdensome return procedures, such as requirements to complete coursework elsewhere while away, mandatory duration of time away, or, specifically with mental health-related leaves, stricter requirements than students returning for other reasons.
Absence of Individualized Assessment: Many cases involving medical leaves have an underlying theme of lacking individualized assessment. In such cases, students have alleged that they were required to take a medical leave based on their diagnoses, rather than on an individualized assessment of their circumstances.
Consistency in Medical Leaves: Instances in which students report unfair and inconsistent adherence to medical leave processes have been cited. Some factors in which inconsistencies have been found include return timelines and documentation requirements.
Where Universities Struggle
In many cases, it’s not the absence of a medical leave of absence policy; it is inconsistent implementation of the policy, burdensome requirements, and discriminatory processes that increase institutional risk. While medical leaves often intersect various offices, university collaboration is also often absent, which affects the student experience. The following questions may help universities better evaluate their current policies to minimize risk while also supporting students:
Has one department been designated to coordinate mental health-related medical leaves of absence?
Who "owns" the medical leave of absence policy for mental health-related leaves?
Which student populations may not be adequately addressed by the policy (i.e., part-time students, off-campus students, and graduate students)?
Do students have a point of contact during their leave to help maintain communication if questions arise?
Do students have access to the policy and leave-related resources while they are away?
Who is returning from leave at your institution? Who is not?
Reinventing the Wheel
In addition, universities can use the following strategies to enhance support and foster trust.
Early Intervention: Students requesting a medical leave of absence often describe challenges that have accumulated over the course of a semester or longer. The circumstances leading to leaves are not always sudden but develop over time. This underscores the importance of universities taking a proactive approach to supporting students at the early signs of a struggle. Creating robust and innovative student care teams can allow institutions to intervene early and connect students with appropriate resources to ensure that students who are struggling are reached out to and provided with the resources to help them thrive.
Embedded Case Managers: Embedding case managers within university wellness centers provides another layer of support for students experiencing difficulties. These professionals play an important role in early intervention by connecting students with campus resources that may help address concerns before a medical leave is needed. When students are on leave, these individuals play a vital role in creating systematic communication and check-ins, providing an opportunity for students to have questions answered, as well as providing an update on their progress toward a successful return.
“Institutions should remember that medical leaves are a transition, not a dead end....”
Enhancing Collaboration Upon Return: Students returning from a medical leave often have needs that extend beyond their mental health treatment, including academic advising, disability accommodations, and accessibility services. A coordinated, cross-departmental approach helps ensure these supports are in place early, promoting a smoother and more successful transition back to campus.
Conclusion
A student-centered approach to managing institutional risk should not be optional; it should be a standard component of every medical leave process. Institutions should remember that medical leaves are a transition, not a dead end, for a student who needs to take a pause from their academics. Annual policy review, cross-departmental collaboration, and learning from other institutions’ experience go a long way.
More than 75% of students with paid GradGuard tuition claims return to school or plan to return. This data point, from a March 2026 survey of GradGuard members with paid tuition insurance claims, highlights the benefits of facilitating an awareness of tuition insurance to students. GradGuard’s Tuition Insurance provides up to 100% refunds for student withdrawals due to mental and physical health conditions. They partner with over 700 schools to help embed an offer of this protection into their tuition payment system.
https://healthymindsnetwork.org/wp-content/uploads/2025/10/2024-2025-HMS-National-Data-Report_093025.pdf
https://www.insidehighered.com/news/student-success/health-wellness/2025/10/30/college-student-mental-health-remains-wicked