Safe and Effective Messaging – The Jed Foundation

When sharing messages about mental health issues and suicide, it’s important to do so in a safe and effective way. You want to make sure you are helping people rather than discouraging them, especially in times of vulnerability. Here are some resources, guidelines and quick tips to learn more about safe and effective messaging.

Always Promote Help-Seeking

  • You are not alone
  • It’s ok to ask for help – it’s available and a sign of strength
  • Treatment works
  • If someone discusses their personal struggles/experiences, it’s important to say they were able to work through tough times because they reached out for help

Refer

Language for Talking about Suicide

  • Say, “died by suicide”; “lost to suicide” instead of “committed suicide” or “shot him/herself”; “killed him/herself”
  • Say, “suicide attempt survivor”; “did not die in a suicide attempt” instead of “failed suicide attempt”
  • Try not to discuss death in detail or means used
  • Avoid describing death by suicide as an “epidemic/crisis,” or using dramatic terms like “skyrocketing” or “trend”

Language for Talking about Mental Illness

  • Say “He is living with a mental health condition”; “She is afflicted with / suffers from”; “She is living with / She has been diagnosed with”; “She has schizophrenia / She is living with schizophrenia” instead of “He is mentally ill”; “She is schizophrenic”
  • Say, “He is experiencing symptoms of” instead of “He is psychotic / disturbed / crazy”

General Messaging

  • Everyone struggles at times, but if a problem is lasting too long, is too intense or feels like more than you can handle, reach out for help.
  • It’s important to learn the warning signs of suicide, self-harm, and substance abuse.
  • Look for changes in behavior, personality.
  • It’s ok to ask for help – it doesn’t mean that you’re weak, or just want attention. Everyone needs help from time to time, and if you or a friend is struggling, you should reach out to talk to someone right away.
  • Trust your gut – if you’re worried about yourself or a friend, don’t hesitate to act and get help. You don’t have to know what is wrong-just that they’re in trouble or struggling.
  • Be direct with your friends – tell them you’re worried and why, ask them how they’re feeling and offer to reach out to a professional and/or family member with them or for them.

More Info

  • Typically, there is mental illness in the context of suicide. Treatment of a mental health condition can make a tremendous difference in someone’s life.
  • Suicide is a tragic, permanent action and should never be the solution to a problem.

Click here to view the full Safe and Effective Messaging page from The Jed Foundation.

Voluntary Medical Leave for Students Experiencing Mental Health Difficulties at College

Many colleges struggle to understand how to enable their mental health leave of absence policies to meet the expectations inherent in the Americans with Disabilities Act (ADA). In this webinar, we will review the experience of one university that worked directly with the US Department of Education’s Office for Civil Rights (OCR) to construct a leave of absence policy. Presenters—SAMHSA and The Jed Foundation (JED)—will discuss the principles that emerged from the OCR’s oversight of developing this leave of absence policy and how these principles can inform colleges about meeting OCR’s expectations. Attendees will gain an understanding of how the OCR appears to interpret the ADA and how to best prepare policies and processes for mental health leaves of absence on your campus.

Click here to access the webinar via SPRC’s YouTube channel.

NaBITA Position Statement on Involuntary Withdrawal Best Practices

Ratified by the NaBITA Advisory Board on February 4, 2019, the following position statement provides recommendations on mandatory (or involuntary) leave, as well as the use of behavioral agreements. Remember to also refer to our JED Campus recommendations here when building your policies.

Click Here to Access the NaBITA Position Statement: Involuntary Withdrawal Best Practices

College Re-Entry Program by Fountain House

Based in NYC, College Re-Entry helps academically engaged 18-30 year-old college students, who withdraw from their studies due to mental health challenges, return to college and successfully reach their educational goals. Their expertise lies in helping students build and implement an action plan to get back to college and develop capacities to do well, both in and outside of the classroom. The Core Program begins with an integrated 14-week (15 hours per week) curriculum that helps a small cohort of students regain academic skills, restore physical wellness, and reclaim social community. Students have the opportunity to work with expert instructors in classes aimed at introducing and strengthening practical skills needed to succeed.

This is a great program for students looking to return to college after taking a medical leave.

Learn more at www.collegereentry.org

Direct Threat and Caring for Students at Risk for Self Harm: Where We Stand Now

This resource, published by the National Association of College and University Attorneys in 2014, proposes some guidelines for safeguarding students and avoiding disability discrimination claims in the absence of formal or clear federal guidance.

View the full document here.

Sample medical leave policies

These are examples of medical leave policies that JED Campus staff feel are strong. Feel free to reference them when you are working on creating or updating your own policies. Remember to also refer to our JED Campus recommendations here when building your policies.

The Bazelon Center for Mental Health Law has also created a model policy to help colleges and universities navigate these complex issues and develop a nondiscriminatory approach to a student who is in crisis because of a mental health problem. The model was developed after consultation with mental health experts, higher education administrators, counselors and students. It is a collection of best practices that all colleges and universities can and should adopt. It places particular emphasis on how to deal fairly and non-punitively with students in crisis, and how to support those whose mental health problems may be interfering with their academic, extracurricular or social lives. It addresses both voluntary and mandatory leave. View the full model policy here.

Tuition insurance programs

Tuition insurance plans refund a portion of unused annual tuition when students are withdrawn or dismissed for covered reasons. The following programs offer parity between medical leaves for physical and mental health concerns. Tuition insurance protects a family’s investment and can remove the fear of financial loss as a reason for a student to decide against getting the care they need (or medical leave). Remember to also refer to our JED Campus recommendations here, and you can view the following programs below:

Dewar – The Tuition Refund Plan

GradGuard – Insurance & Protection Products for College Life

GradGuard Tuition Protection Plan Policy from Allianz 2019 – 2020

Below you will find examples of how JED Campuses have advertised their tuition insurance policies.

Felician University — Tuition Insurance Flyer

Student Mental Health and the Law [JED]

This guide explains FERPA, HIPAA and disability law in addition to other complex legal topics schools can face related to student mental health.  The goal of this document is to provide all campus professionals with a summary of applicable laws and professional guidelines, as well as related good practice recommendations, to support well-informed decision making around students at risk. The good practice recommendations reflect input from round-table participants, key research findings, and previous work of JED and other organizations.

You can view the full guide here.

Framework for Developing Institutional Protocols for the Acutely Distressed or Suicidal College Student [JED]

This guide, developed by JED with input from expert professionals, provides your college or university community, regardless of its size, culture, and resources, with a list of issues to consider when drafting or revising protocols relating to the management of the student in acute distress or at risk for suicide. This document is a tool to aid your institution in developing or revising protocols related to response, emergency contact notification, and medical leave of absence.

View the full guide here.

JED Recommendations: Leave Policies and Protocols

PROVIDE MENTAL HEALTH AND SUBSTANCE USE/MISUSE SERVICES:
LEAVE POLICIES AND PROTOCOLS

 

A school will benefit from having leave policies and protocols support students in distress.
This is one of five main objectives in the Mental Health and Substance Abuse Services domain.
Under this objective, schools may take the following action steps:

 

  • Disclaimer:  These recommendations are high level in nature (not meant to be exhaustive)  and should not be construed as legal advice or guidance.  Campuses need to consult with their general counsel to determine if their policies and procedures are in alignment with rulings from the Department of Education, Office for Civil Rights, the United States Department of Justice, and/or other regulatory guidance.  Definitions
  • Voluntary Leave of absence:  A voluntary leave of absence (LOA) is granted by the college in which a student is enrolled.  A LOA is a temporary interruption of a student’s program during which the student is considered to be enrolled.  Under most federal and state requirements an LOA cannot exceed 180 days in any 12 month period without potential implications for financial aid repayment.  Please check with your local/federal financial aid regulations surrounding this.
    • Medical leave of absence:  A medical leave of absence (MLOA) is when a student needs to take a leave due to a mental health or physical health issue.  For more information on LOA’s see this guide here.   
  • Involuntary/Mandatory Leave of Absence: When a student is unwilling to take a voluntary leave of absence and an individualized assessment based on objective evidence indicates that they pose a serious risk to the health and safety of others in the community, the school should have a process in place requiring the student to take an involuntary leave of absence.  These policies should be used rarely and be a last resort as described below.
  • Withdrawal:  An official withdrawal is when an enrolled student decides to leave their college/university after their semester begins.  JED Campus Recommendations for Leave PoliciesDevelop/refine a written voluntary medical leave of absence policy consistent with the following recommendations:

    Establish a central office to administer and coordinate all leaves to ensure consistency and eliminate confusion for the student. In this office the students can discuss the decision to take a leave and/or consider possible accommodations that might allow them to remain in school. The central office should:

    • Review reasons for the leave request
    • Discuss potential accommodations to allow a student to remain in school and avert a leave of absence.
    • Discuss the impact on academics
    • Discuss financial considerations, including tuition insurance and tuition refunds
    • Review the student’s transcript and scholarship status.
    • Consider the specific issues for graduate/professional students such as, graduate assistantships, grants etc.
    • Discuss visa and insurance implications for international students
    • Discuss the possibility of a leave collaboratively with the student. If they decide to take a medical leave of absence, frame it as a positive step that the student is taking to support their wellbeing and overall success.

    Consider reasonable accommodations to allow a student to remain on campus and avert a medical leave.

    • Create virtual accommodations, where possible and reasonable, so that students can participate in social, academic, and other activities while off-campus (for example if a student is hospitalized with a mental health condition).
    • Encourage faculty to implement pass/fail grading/non punitive coursework options for students to help students stay on campus during difficult periods. 
    • Encourage faculty to provide flexible attendance policies.

    Seek to create and maintain leave policies that are transparent and easily accessible to the campus community. 

    • The policies need to be accessible via the student handbook, the faculty handbook and easily searchable. Consider disseminating the policy to parents/families, faculty, academic advisors, athletics, students, financial aid, etc. 
    • The medical leave of absence policy should include clear and concise explanation of the college’s expectations for the student while they are on leave that are fully and concretely explained. This should include a description of documentation required for a medical leave.
    • An individualized assessment should be done with each student to develop a wellness plan that might include clinical treatment. Work to ensure that any treatment is culturally and identity relevant.
      • Inquire about financial resources/insurance coverage to meet these goals. 
      • Encourage students to build social connections and sleep/nutrition/exercise practices into these plans.
    • School policies should allow for decisions about length of time and terms of medical leaves on a case-by-case basis.
    • The medical leave process should be well coordinated among relevant offices and the college should assist students in appeal processes for tuition and housing costs.
    • Provide the student with a written summary letter of the details of the voluntary leave process, the details for what they need to do to return to school, and any other details to which has been agreed.

    Once a student has decided to take a medical leave of absence, where possible, support for students while on leave might include: 

    • The facilitation of avenues for students to access mental health resources while on leave in their communities.
    • Virtual academic and community support for students while on leave.
    • Campus staff who can reach out to, and support students on leave.

    A return from leave policy should be established and a checklist should be provided to the student.

    • There should be clarity around timelines, deadlines, and documentation for returning from leave. The return from leave policy should include the following:
      • A requirement to submit a formal written request that includes:
        • The current status of the problem
        • Treatment received, or ongoing, for the problem
        • A supportive meeting with the student to review the recommendations regarding return, including treatment plan (can be in-person or via Zoom/phone)
          • The return from leave clinical documentation should be sent directly to the Health Center for physical conditions or the Counseling Center for mental health conditions (in cases where the Counseling Center was involved in student treatment before the leave).
          • The Health or Counseling Centers should make a recommendation regarding a student’s readiness to return from leave to the designated office who oversees the leave process (for example, Dean of Students, VP of Student Affairs)

    Upon return from leave, the college might support students in the following ways: 

    • Provide wellness coaching upon their return to the university that encourages students to adopt healthy habits, connect with their peers, set a workable schedule, and utilize mental health resources.
    • Ensure financial/personnel resources to provide counseling and support for returning students.

    There should be parity (non-discrimination) in policy/procedure for students leaving for physical and mental health issues.

    Offer a tuition insurance policy that has parity between medical leaves for physical and mental health concerns. Tuition insurance protects a family’s investment and can reduce the fear of financial loss as a reason for a student to decide against getting the care they need (or medical leave).

    • The school may write a letter to families that outlines the benefits of participating in a tuition reimbursement plan, specifically:
      • Very little cost for plan versus potential cost for loss of tuition
      • Covers unexpected occurrences
      • Encourages students to get the care they need when they need it without having to weigh significant financial loss as a factor in their decision
    • The tuition insurance plan will offer the same reimbursement coverage for leaves due to mental health issues as for leaves due to physical health issues
      • The tuition insurance plan will provide parity in conditions for reimbursement – for example, some policies require hospitalization for mental health issues as a precondition for reimbursement, but only a note for reimbursement for medical issues – this type of inequity should be avoided.
      • The school’s tuition reimbursement policies can also be established to provide a better reimbursement schedule for students who take legitimate medical leaves.

    Develop/refine a written involuntary/mandatory leave of absence policy consistent with the following recommendations:

    As discussed above, on the rare occasion that a student is refusing/unwilling to take a leave of absence and poses a serious risk to others and/or is causing serious campus disruption based on their behavior, it is important for schools to have a policy in place for involuntarily withdrawing the student and for addressing the disruptive behavior. Keep in mind that in 2011 the Department of Justice stated that these types of policies should be considered when there are concerns about danger toward others only.  There is still confusion/ambiguity as to when/how/if such policies may be implemented when there are concerns about a student’s potential danger toward self.  

     A few considerations when developing these policies are below:

    • Provide an individualized assessment  to evaluate whether an involuntary leave is indicated. The DOJ articulated how “direct threat standard” may apply and is central to making determinations about an involuntary leave. 
    • The policy will indicate that suicidal ideation ALONE is not a justification for mandatory leave. Schools and their legal counsel should review carefully the DOJ changes from 2011 on this topic.  
    • The policy should consider mandatory leave when:
      • The school has exhausted reasonable efforts and accommodations to assist a student’s ability to remain on campus
      • The student’s behavior is a material disruption of, or direct threat to the campus living and learning community and/or its members
    • The school will provide a clear process for appealing a leave decision
    • There will be policy in place to consider/encourage communication with families around plans for leave and return, consistent with state and federal privacy law requirements
    • A mandatory leave of absence should be rare and given only after all other efforts have been applied to keep a student in school.

THIS CONTENT CAN ALSO BE FOUND IN THE JED CAMPUS PLAYBOOK GUIDE.
To view all playbook resources related to Leave Policies and Protocols, click here.