This is part II in a three-part series. Part I ran in The Crimson’s Commencement Year in Review issue last May and was reprinted on April 28. Part III ran on April 30.

Before Ella took a leave of absence from Harvard, she struggled with the pace of undergraduate life, so much so that she was hospitalized to recover from suicidal thoughts.

“Going to college, I was like a chicken with my head cut off,” said Ella, whose name has been changed due to the sensitive nature of this subject. “I made a four-year plan for every single concentration because at some point I considered being in every single concentration.”

By the time Ella settled on a concentration her sophomore fall, she hated the work that she was doing. After finding herself in a bed at McLean Hospital, she made the decision to take time off from being a Harvard student and go home.

Just like many of her peers who take time off, Ella returned from a year at home feeling grounded and ready to tackle Harvard life once more.

“I knew who I was—I know it’s cliche—but that helped me figure out what I wanted to do,” she said.

The process by which students take leaves of absence from the College for mental health reasons involves complex decision-making, often after missing assignment deadlines, taking on an overwhelming workload, or even being involuntarily hospitalized.

For most, taking time off allows them to heal in an environment removed from the chaos of Harvard life and return to campus, while, for others, the initial leave turns permanent. Across the board, however, students balance the benefits of time spent beyond the Harvard bubble with the pressures of University requirements and bouts of loneliness as their peers continue to go to school.

ON LEAVE FROM CAMPUS, AND UHS

From the Bureau of Study Council to University Health Services, Harvard often boasts of the range of mental health services it provides to its student body. Yet, students say, when these offerings fall short, students often take leaves of absence and seek some form of professional treatment without any of the financial or medical resources available to their peers on campus.

The Administrative Board bases its decision about whether or not to allow a student to return to campus solely on the input of UHS, which typically asks the student to demonstrate a “period of stability” and regular medical treatment, according to Secretary of the Administrative Board John “Jay” L.  Ellison.

While Harvard effectively requires all students to seek out this treatment during their time off, after a brief transition, the University does little to ensure that students away from campus have access to the highest quality care.

Enrolled students can be treated under the school-wide insurance policy, yet UHS does not provide students on leave with direct support services, according to a joint statement by Director of Harvard University Health Services Paul J. Barreira and Chief of Student Mental Health Services Katherine A. Lapierre.

For students with financial constraints, the cost of required therapy can present a significant burden in the midst of the difficult process of recovering from mental health problems.

“I think the whole process is kind of insensitive to low-income students,” said Kate, who did not have health insurance when she took a leave of absence last year. Kate’s name, as well as those of several other students quoted in this story, has been changed due to the sensitive nature of the subject.

“I was paying for all my  treatment out of pocket, which is extremely expensive,” she said.

According to Ellison, Harvard does not provide students on leave with insurance because, as a non-profit University, Harvard only sells policies to current students.

“That’s not the business we’re in. The business we’re in is students,” Ellison said. “It’s illegal for us to insure someone who is not enrolled.”

A student who withdraws will receive the applicable student coverage until the last day of the month of the official last day of attendance, according to the Student Health Program website. The student is also eligible to purchase four additional months of coverage in order to help “facilitate a student’s transition from HUSHP to other outside insurance and is only meant to be for a limited duration.”

Once students can finance their treatments, however, they say that  seeing a professional outside of the Harvard environment can be beneficial for their path to healing.

“I think students [on campus] can sometimes see going to therapy or going to get help as one more thing they need to do,” Sharon L. Howell, the resident dean of Adams House, said in an interview last May.

This atmosphere creates a difficult environment for students to get better, said Karina Partovi ’14-’15. Before she took a leave of absence, Partovi saw a professional in UHS who she said struggled to address her concerns with mental health.

“I mean [my therapist] was nice, there was nothing wrong with her, but she was—she didn’t reach me,” Partovi said. “But to be fair, I don’t think anyone could have reached me.”

Yet, once students leave the Harvard bubble, they say that therapy—even when medical offerings available at home are far more limited than those at Harvard—often works better in a new environment.

“There are very very few places in the States or in the world where you can’t get some kind of care,” Ellison said. “What UHS does do is try to help the students and their families think about the transition from our mental health or our physical health to their hometown or their local hospital or local physicians.”

A DIFFERENT KIND OF HOME-WORK

For Ella, receiving therapy and seeing a psychiatrist in the first month of her leave of absence inspired her to find a job in the medical field to fulfil the “period of stability” requirements set out by UHS, working as a research assistant for a geriatric clinic near her home.

One thing led to another, and soon Ella was taking a position as a health care access intern, intent on switching her concentration, fulfilling the requirements to apply to medical school, and dedicating her career to medicine.

Like nearly all students who take time off for mental health reasons, Ella found a job to demonstrate to Harvard that she was ready to enter back into the schedule of a student. But, for many, these jobs appear to play a much more active role in the process of getting better, giving students new direction and stimulation during their leaves of absence.

Partovi, who says she was “shell-shocked” at the beginning of her time off, found a job working as a teacher’s aide at her old elementary school after spending a couple of weeks lying in bed and playing computer games.

According to Partovi, in the first few weeks following her decision to leave, she felt angry at Harvard and her resident dean for what she said was effectively giving her a choice between leaving voluntarily or being forced out by the school.

“There were some times when I didn’t think I would come back to Harvard ever, that I’d never come back to college,” Partovi said. “But working, I realized how much I really wanted to be back, how much I actually loved school and loved Harvard.”

Alexander G. Smith, who similarly grappled with the idea of not returning to Harvard during the initial months of his leave, said that finding a full-time job in the fall and returning to a normal schedule significantly improved his leave. “Everything just seemed to fall into place,” said Smith, who took time off partway through his sophomore spring semester in 2013.

The process of finding a job is similar for most students who take time off: after spending several weeks at home and doing relatively little, they secure a position and work for about six months.

According to Ellison, although UHS asks students to demonstrate a period of stability—typically lasting six months—during their time off, neither the Ad Board nor UHS explicitly requires that students obtain a job. Still, working can be a strong signal that a student is prepared to come back.

“Students are not required to work while on leave, but it is important for HUHS and the College to know that a student is ready to return,” Barreira and Lapierre wrote in their statement. “This can be done in a number of different ways, including working, volunteering, or taking a class, all of which have been found to be good indicators of readiness to return to campus.”

David, whose name has also been changed, did not mention his clinical depression when he sought time away from the Harvard campus in order to avoid requirements like the “period of stability.” After declaring his intention to “explore possible options for careers,” his resident dean easily facilitated his time off—without any mention of requirements for his return.

But the details of this requirement to come back to campus are not entirely clear to some students who take leaves of absence. Several students reported different accounts of the school’s policy on work during leave, which according to Ellison does not “necessarily have to be for pay.”

According to Kate, administrators told her that she must secure a paid position during her time off, which she says forced her to take a job at a fast food restaurant.

“I can’t work at the White House because its unpaid, but I can work at McDonalds because it is paid,” she said.

For most students, however, working during their time off is not only a critical way to demonstrate to UHS that they are fit to return to campus but an important part of the healing process.

Students say that working at a consistent job, whether that be at McDonald’s, a bookstore, or a health care clinic, helps establish a regular routine that is integral to the process of getting better.

“It was a very good experience, not because it was the best job in the world—there were many times when I was frustrated by it—but it was an experience that was very far removed from the cultural climate I was experiencing at Harvard,” said George, who worked at a bookstore during his time off. “I found that to be part of that environment, and just to be working for the paycheck, it was great.”

GETTING BETTER, BUT FEELING WORSE

When George initially decided to take time off for mental health reasons, he only focused on the immediate benefits of removing himself from the Harvard environment. But several months after his recovery was underway, George began to feel not only ready to go back to school but also lonely because he could not for another six months.

“It was at that point that some of the positive gains from taking time off started to retract a little bit,” he said. “I started to be very fed up, I was very bored, and I didn’t have a lot of stimulation in my life. I just didn’t have a lot of connection, because there weren’t many people I knew who I could see, and I felt lonely. ”

Despite having a good relationship with his parents, George struggled to adjust to the new social atmosphere. “I was happy to a degree, and I was satisfied, but it wasn’t easy.”

In the midst of working full-time, seeking therapy, and spending time at home in an effort to get better, students said that they cannot help but feel lonely during their leave. For most students, human connections are limited to close family and friends at home, while the individual’s peers remain together in classes, dining halls, and activities back in Cambridge.

Partovi said these relationships nevertheless made a “big difference” during her leave of absence. Beyond her hours working at a local elementary school, Partovi spent most of her time with her family, often attending her sister’s high school dance team performances.

Many students on leave strive to maintain an emotional connection to the school through their friends and Harvard affiliates despite being physically separated from the University.

Smith, who is still on leave from campus, says that while he keeps in touch with his friends back at school, the distance has changed their relationship.

“It’s not like I talk with people every night or even every week, but I stay in touch in the way that a friend from back home would stay in touch,” he said.

These connections with friends from school, however, are not enough for most to combat feelings of loneliness while spending time away.

“If there’s a single hardest thing about taking time off and spending that time off at home, [it] is certainly the solitude,” said David, who nevertheless was able to stay in touch with professors and peers as a teaching fellow for HarvardX.

This loneliness, while perhaps harmful to students while on leave, can help motivate them to return to campus.

George, who returned to campus this fall, says he felt ready to return soon after the loneliness struck.

“I was so ready for August to begin so that I could feel like the student I was supposed to be,” he said.

—Staff writer Steven S. Lee can be reached at stevenlee@college.harvard.edu. Follow him on Twitter @StevenSJLee.

—Staff writer Dev A. Patel can be reached at dev.patel@thecrimson.com. Follow him on Twitter @dev_a_patel.