Documents shed light on how Princeton handles mental health cases

In March 2012, Vice President for Campus Life Cynthia Cherrey gave a student who had attempted to commit suicide a month earlier an ultimatum: Take a voluntary withdrawal sometime in the next four days or be forced to do so.

“I do hope … that you will reconsider and take a voluntary withdrawal by no later than March 30, 2012,” she wrote in the final paragraph of a two-page letter. “If you do not choose to do so, I will require you to withdraw, which would then be reflected on your transcript.”

Earlier in the letter, Cherrey had cited seven distinct sources of medical information she had personally reviewed, including a summary of treatment written by Counseling and Psychological Services and which, she said, had been released to her with the student’s permission.

Her conclusion, in consultation with Dr. John Kolligian, the director of University Health Services, was that the student posed an “unacceptably high risk of intentional self-harm and the demands of a rigorous academic program in an intense university context would only increase that risk.”

The letter is part of a set of four previously confidential pieces of correspondence released by the University last week as part of a federal court lawsuit challenging its mental health practices and policies. One of the letters is a match almost word for word to a letter published in The Daily Princetonian last spring that detailed the conditions for readmission following a leave of absence for mental health reasons. The letters were sent almost a year apart, one in 2012 and the other in 2013.

The documents, as well as interviews with the plaintiff and one other student who is currently taking a leave of absence for mental health issues, shed light on the controversial and often ambiguous process the University uses when considering cases of mental illness.Most notably, they show just how insistent the University can be in requiring withdrawal when it has determined that withdrawal is in the best interest of the student, and how blurry the line between voluntary and mandatory withdrawal can be.

The University does not comment on matters of pending litigation.

The Letters and the Meetings

In late February, the student, who uses the pseudonym W.P., swallowed 20 Trazodone tabletsand then immediately began to try to vomit them out. He let less than a minute pass, he said, before he sought help at McCosh Health Center and was transferred to the University Medical Center of Princeton at Plainsboro.

W.P.’s first meeting took place while he was still at the hospital, with then-Wilson College Director of Student Life Michael Olin. In an interview, the student said that he was then told he was now banned from campus. Soon afterward, another meeting was held during which, W.P. alleges, confidential medical details were disclosed by then-CPS Director Anita McLean, and he was informed that the “universal outcome” in such cases was voluntary withdrawal, even after presenting letters from his off-campus psychologist that recommended he stay enrolled.

“I was informed that it was the universal result in all cases like this, that there were no exceptions, that I must take a year off,” he explained.

In a letter sent to W.P. about a week after the suicide attempt that summarized the first few meetings that had taken place, Dean of Undergraduate Students Kathleen Deignan informed him of the results of his “formal post-hospital evaluation” performed by McLean and a University psychiatrist. In it, Deignan wrote of the “substantial behavioral instability” W.P. exhibited during his first meeting with Olin in the hospital, the University’s “profound concerns for his safety” and the improbability of another evaluation yielding different results.

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In addition, the letter said W.P. seemed to be at “extremely high risk of having another dangerous episode” and noted that this was the student’s third suicide attempt in the past 14 months. Furthermore, it stated W.P. had cut short his treatment at UMCPP against medical advice and had not engaged in psychological or psychiatric treatment following the incident.

If the student were to request a new evaluation to determine his mental health, Deignan wrote, they would perform it under the condition that the student release his medical records within and outside the University for the past 12 months.

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Overall, four letters addressed to W.P. were released by the University. Two of them detail the back and forth leading up to his decision to accept the voluntary withdrawal condition, while the other two letters explain the readmission process.

Requests for alternative accommodations outside campus were denied, and in appeal meetings he was told that off-campus accommodations or a reduced courseload would “fundamentally alter the nature of a Princeton education,” according to one letter.The University’s defense has used the exact same wording in court papers in response to a claim alleging housing discrimination.

W.P. said administrators never tried to define what they meant, and he compared the experience to Franz Kafka’s “The Trial.”

“Everywhere you go you’d try to say something logical, and you’d be met with this wall, this firm ‘that doesn’t fit with the Princeton experience,’ ” he said. “What they eventually used to get me out of school was pretty clever.”

W.P. said he was informed that he had missed too many classes to pass his Writing Seminar and his Spanish class, and that he would be better off withdrawing from the University. Finally, three weeks after he was first asked to withdraw, Cherrey’s letter asked him to voluntarily withdraw or be forced to do so within the next four days.

“I understand that you sincerely feel that you are able to return to your academic studies,” Cherrey wrote in the letter. “I disagree.”

“I almost have respect for how clever it was,” W.P. said in response.

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A different student, who last academic year wrote an anonymous op-ed in The Daily Princetonian describing her experience with the University’s mental health process, described the series of events leading up to voluntary withdrawal as a “cookie-cutter … [one] that seems to be very rigid and inflexible,” one that made her feel violated and ostracized.

Unlike W.P., she said, she had never attempted suicide and yet was treated in the almost exact same way.

“It seems like they ignored those details, and that’s what makes them so scary,” she said.

Both students received nearly identical, word-for-word letters during their year off with instructions about the readmission process, a letter the female student included in her op-ed in the ‘Prince’ last year.

“Prior to your readmission, you must undergo a readmission evaluation at the University’s Counseling and Psychological Services,” both letters read. “It will also be necessary for you to sign two copies of the ‘Authorization for Release of Information’ form: one authorizing your treatment providers to discuss your progress with our clinical staff at CPS, and one authorizing CPS to discuss your readmission evaluation with us.”

However, W.P.'s letter included an additional section describing the extent to which he would be allowed to visit campus during his time off. Although he would be allowed to visit public events such as athletic events and theatrical performances, the University did not "expect" him to visit dormitories, dining halls or other locations meant for the campus' residential community.

"If you wish for us to make an exception so that you, for example, might visit a friend, we are willing to entertain an occasional request to that effect," read the letter signed by Olin and then-Associate Dean of Undergraduate Students Cole Crittenden

In hindsight, both students said the process was unpleasant.

“It was a process that made me feel alienated, like they don’t want me there, like all of a sudden I’m gone,” the author of last year’s op-ed said. “It’s like they’re saying, ‘You need to prove to us that you deserve to be back.’ ”

“I felt bulldozed – they played hardball,” W.P. said. “I did not expect them to boot me for a year, kick me off campus, to really screw me quite so hard.”

Off-Campus vs. CPS

The female student said she was already planning to take a year off in fall of 2013 but had heard so many negative stories about her peers’ experiences with CPS that she refrained from mentioning it was for anything more than “medical reasons.”

Both the author and W.P. say they had been regularly visiting off-campus treatment providers for their mental health issues. Both highly recommend that students choose this route whenever possible. When asked if students should ever visit CPS, both said it should be a last resort.

“It’s easier for students to be completely open if they don’t have to check their words,” the author said. “My only fear is that students won’t want to be completely open because they’re scared of the process – it’s hurting their ability to get better.”

W.P. said that if he ever donates to Princeton, he would like to set up a branch of CPS that is unaffiliated with the administration.

“I’d donate like $3 billion for that shit,” he said.

However, both did visit CPS a few times, and both say their records were not kept confidential – in fact, they say they were forced to waive their right to the records during the withdrawal process.

“They didn’t even know the severity of what I was going through, they just knew that I was depressed,” she said, adding that, at that point, “everything changed.”

Moving Forward

Managing a lawsuit against the University while also a student here, W.P. said, is like “an extra class that I have a very, very intense personal interest in.”

Though he is representing himself pro se, both W.P.’s parents are law professors and have helped him navigate the process.

He said his hope for the lawsuit is that it changes the standards for how the University handles cases like his own.

“We can’t have unprofessional people who are just flagrantly violating their professional oaths around an institution of higher learning like this,” W.P. said. “Princeton is obviously in a business of intimidation here.”

As the suit moves forward, W.P. said he plans to amend the complaint in response to a motion presented by the University last week seeking to dismiss a number of claims and to remove former University President Shirley Tilghman as a defendant altogether.

A hearing for this motion will be held in early November.

The female student said her main issues with the process were in its rigidity and inflexibility – that the University became a foe rather than a friend. She said it is this aspect of the process that often keeps students from coming forward with their illness – a “matter of life and death,” as she said in her article.

Both W.P. and the female student said that, despite everything the administration put them through, they do still love the University – in particular, the students and the professors – and want to be here.

The author emphasized that she does believe the University has the students’ best interests at heart and is merely unequipped to properly handle cases of mental illness.

“They way they’re doing things now, it sends the message, ‘If you come to us, we’ll kick you off campus. This applies to everyone no matter the severity level.’ ”

Her suggestions include weighing input from outside psychologists more and working with students after they have left to make them feel like a continuing member of the community.

“I love Princeton. I believe that their motives behind this are pure – I believe that they do look out for the students, but I’m not a fan of how they’re doing what they’re doing,” she said. “I just have this perfect, idealistic scenario in my head of how they could be doing things to become more of a friend, instead of a foe.”

“I’m not fond of the administration, but my professors and my friends showed me an outpouring of respect that I didn’t expect, maybe didn’t deserve,” W.P. said. “Not everyone here is out to crush me.”