Wesley Lynch was about 150 miles from Mount Holyoke College, and about eight credits away from earning a bachelor’s degree, though she hadn’t been enrolled in school full time in seven years.

She was sitting in front of a desktop Dell in a converted brownstone in New York City, clicking through lessons in an online psychology class about stress, when she heard the word “resilience” for the first time. It resonated.

Lynch had left school just before Christmas in 2011, when she was 22, in the middle of a major depressive episode.

“I don’t want to say it was, like, impossible for me to do it,” Lynch said recently, recalling her struggle to remain on campus. “But I was just really, really sad and depressed all the time. It was hard for me to even — even breathing felt really hard to do.”

The psychology class was part of a program run by the nonprofit Fountain House where Lynch, alongside other students who had left college because of mental health challenges, learned how important it is to have basic needs met. In order to recover from her unplanned detour and be strong enough to complete her degree while coping with her depression, she realized she had to make a commitment to eating well, getting good rest and doing some form of exercise daily.

“Basically, when I was depressed at Mount Holyoke, that went to the wayside. All of that went to the wayside,” she said.

What had begun as a tentative plan for Lynch to finish her last assignments from home, in Brooklyn, turned into a leave of absence and then an extended hiatus. Lynch moved back in with her parents, got a job in a restaurant and then in a clothing store, and started going to therapy regularly.

Twice, she enrolled in community college courses to inch her credits toward the number needed for her bachelor’s degree. The first time, she floundered and withdrew. The second time, she muddled through a few courses but still came up short. Eventually, Lynch applied for a scholarship that would pay for the 14-week program designed to mimic a college semester and prepare her to go back and get her degree.

People of traditional college age, between 18 and 25, are also in the age group that is more likely than any other to experience mental illness, and most mental health conditions develop by the age of 24. Despite the prevalence of mental health issues, experts say most students with mental health conditions will not need to take time off from college to deal with them or receive treatment.

But approximately 113,000 students took leaves of absence in 2021, which included medical leaves for mental health reasons, according to the National Student Clearinghouse. The Clearinghouse did not provide information on how many leaves were for mental health reasons, or on how long students typically were out of school. The Department of Education does not track leaves of absence.

Related: Burnout symptoms increasing among college students

There are programs specifically designed to help students on a leave of absence improve their mental health and prepare to return to campus, but they are few, and most are prohibitively expensive. Mental health and education experts are working to develop shorter, more accessible models that can be used on any campus and help ensure that more students are able to successfully return from leaves of absence and earn their degrees.

The stakes are high for a student trying to return to school after a mental health leave of absence:  thousands in tuition dollars and a college degree that could secure economic mobility for the future. And there is even more on the line for students who depend on their college for health insurance, housing, food and campus jobs to subsidize their living costs. 

“Taking a leave of absence essentially would end up pulling the plug on all of that as our system is right now,” said Zainab Okolo, a licensed marriage and family therapist and a strategy officer at the Lumina Foundation. (The Lumina Foundation is among the numerous funders of The Hechinger Report.)

She pointed to racial disparities in mental health care and said that because not all insurance companies cover mental health care in the same way they do physical health care, people may have to pay out of pocket for treatment. If they don’t have the money, they are out of luck. 

“It is always a privilege to be able to take a pause out of life, to take care of any one particular section of life,” Okolo said.

The leave of absence process varies by institution, and beyond the paperwork required to leave and re-enroll, it’s often unclear exactly what students should do to ensure that when they come back, they will be able to successfully balance their mental health condition with their academics and earn a degree.

Students who need to take time off are often experiencing an acute crisis or have been trying to cope with a chronic condition, and, like Lynch, have reached a breaking point, said Amy Gatto, the director of research and evaluation at Active Minds, a nonprofit that advocates for college students’ mental health.

Experts say students who take leaves to address mental health are often able to get back on track after they are supported by a three-pronged approach: therapy, medication and psychiatric rehabilitation, which helps a person develop the skills needed to manage stressful situations and re-engage with the community in the most independent way possible.

But programs that offer psychiatric rehabilitation for this demographic are few. And because they are not technically therapy, they are not covered by health insurance, so families have to pay out of pocket.

For example, Fountain House’s College Re-Entry program, which Lynch attended in New York City, offers academic skills, general health and wellness skills, resource coordination, support and mentorship to help students preparing to return to college to finish their degrees. The program targets students who are receiving treatment for various mental illnesses including major depressive disorder, bipolar disorder, anxiety disorders and psychotic disorders such as schizophrenia. Attendance for the nonresidential program four days a week for 14 weeks is $7,500. The pandemic prompted the development of a virtual version of the program, which costs $3,000.

If students who need to take leaves don’t, Okolo said the risk is grave: “The danger of students staying on when they actually need help, or need a time to pause, is that they can fail, is that they can waste their investment, or is that they can push themselves over the edge mentally or emotionally in pursuit of their academics.”  

For Lynch, no single big crisis prompted her to pack up her dorm room and ask her parents to drive from New York to Massachusetts to pick her up. It was a million little things. There were days when it was hard to get out of bed. She completely lacked interest in and motivation for her anthropology coursework, which she had previously loved. And she became overwhelmed by self-doubt.

Though eventually it became clear that she did want to go back to school, she was nervous.

“I hope it’s not gonna be one of the situations where I’m going to school and I’m gonna, like, freak out and not do what I need to do,” Lynch said, recalling her frame of mind upon returning to college. “If I’m going to go back to school, I want to make sure that I’m going back for the right reasons and know that I’m going to be able to succeed.”

Related: Inside a college counseling center struggling with the student mental health crisis

Preparing students to manage the classroom stressors upon their return to campus is central to the curriculum that programs like Fountain House’s offer.

The semester structure of the program reacquaints students with the flow of college, and non-credit writing and study skills courses help them feel more confident after they have been out of the routine for a while, said Anna Guimaraes, director of Fountain House’s College Re-Entry program.

In an effort to help with stress management, the program also covers staying on top of emails so that opening the inbox doesn’t feel overwhelming, what students should do if they miss an assignment and how to communicate with professors.

Lynch said that even before her depression took hold when she was at Mount Holyoke, she struggled to keep up with reading and writing assignments. And she found the noncredit writing class at Fountain House challenging, too. But after she made it through, she felt more ready to take on the last couple of courses standing between her and her degree. She stayed in close touch with the coach she’d been matched with through the program, who continued to help her in a variety of ways.

Besides the online psychology course that introduced Lynch to the concept of resilience, the program teaches other strategies for coping with day-to-day life.

College students are already “at the pinnacle of stress,” Guimaraes said, so it’s especially important that they have coping skills ready if their mental health condition might be triggered by stress. The students learn about mindfulness, and sometimes have classes like financial literacy or cooking.

In a similar program at the Center for Psychiatric Rehabilitation at Boston University, Paul Cherchia, co-director of the College Mental Health Education Programs, said students also learn about what healthy relationships look like and how to navigate social situations. The program, called NITEO, is named after a Latin verb meaning “to thrive.”

Cherchia is a licensed mental health counselor, but the individual work he does with students in the NITEO program is not therapy.

Therapy is more about treating the mental illness, while the coaching component of these types of programs functions more like teaching, Cherchia said. It’s action oriented, he said, centering on things like helping students learn to navigate big, complex systems, like a college’s financial aid office, and grasp concrete skills that will help them when they are back in the rush of everyday life in school or at work in the future.

The coaching addresses the kinds of things that separately may not sound like huge barriers to completing college, but when combined with academic stressors and mental health challenges, could be “the straw that breaks the camel’s back,” said Courtney Joly-Lowdermilk, associate director of strategic initiatives at BU’s Center for Psychiatric Rehabilitation.

“If I’m going to go back to school, I want to make sure that I’m going back for the right reasons and know that I’m going to be able to succeed.”

Wesley Lynch, who took a mental health leave from college before returning

The program ends up functioning as a judgment-free dress rehearsal.

“These are very skilled and bright students who are learning,” Joly-Lowdermilk said. “They’re learning, and what the program did is just give people space to practice more. They haven’t learned the skills. That means you have to create a space where they believe that it is OK that they’ve not learned the skills.”

The NITEO program, which also follows a semester structure, costs $13,000 for students to attend three days a week and receive coaching, Cherchia said. A shorter summer session is offered for $5,000, and scholarships are available for both durations. Though the program is based at Boston University’s campus, Cherchia said it often serves students from other schools in the area and accepts students from any institution. There is no residential component, so most students have a family connection in the Boston area or find a place to rent for the time they are in the program. NITEO serves between 15 and 20 students during a given semester, Chercia said.

As students are working to prepare to return to school, the program also offers free coaching to their parents and family members, which Joly-Lowdermilk said is essential so that families can continue to support the students’ new habits after they are finished with the program.

18 to 25 — The ages at which people are most likely to experience mental illness

If students “come home trying on the new skills that they’ve learned of upholding boundaries, and communicating their emotions, and things that might be new to the family, it’s often met with some defense and adversity. And so students are like, ‘I wish my parents could learn this, too,’ ” Joly-Lowdermilk said.

Programs like these are designed for students who are nearing the end of their leave of absence or have a treatment plan that allows them the time to participate. But psychiatric rehabilitation looks different for students who are still receiving inpatient treatment or more intensive outpatient care.

The McLean Hospital outside Boston treats people of all ages with mental illnesses. Several years ago, hospital workers realized they were seeing a large population of college students who had no clear strategy for their particular life stage, said Stephanie Pinder-Amaker, the founding director of the College Mental Health Program at McLean.

Related: More students are dropping out of college during Covid

At McLean, the student-patients work on resilience skills in a weekly support group model, instead of a structure that mimics a college semester. The program is free for students who are receiving inpatient treatment or attending a support group within the unit where they are receiving treatment.  For students who are not receiving treatment at the hospital or are phasing out of it, the cost is $65 a week. McLean, a psychiatric hospital associated with Harvard Medical School, accepts private insurance. 

Pinder-Amaker said that now, a lot of what the program does is help students design an effective leave of absence and understand how to assess when they are ready to go back. 

As they help students with mental health conditions to thrive when they re-enter college, such programs also share what the leaders say is a powerful design structure: connecting students who would otherwise be isolated.  It is meaningful, the leaders said, for the students to know they are not alone in their struggle, and to learn from one another as they navigate the time away from school.

“You have to create a space where they believe that it is OK that they’ve not learned the skills.”

Courtney Joly-Lowdermilk, associate director of strategic initiatives, Boston University’s Center for Psychiatric Rehabilitation

Because of both their scarcity and their cost, these psychiatric rehabilitation programs are accessible to very few students who take mental health leaves from school.

Over the last few years, Joly-Lowdermilk said, the College Mental Health Education Programs team at Boston University has been working to translate its one-semester course into a curriculum that can be taught on campuses across the country.

The program, called LEAD BU — LEAD stands for Learn, Explore, Access and Develop — can serve students on a leave or those who are still enrolled in school as a sort of preventive measure, equipping them with coping and resilience skills before they are in crisis. It is offered at six partner colleges across the country and online for any student. The course, which is often available for free, was designed in English but is also being offered in Spanish at Boston University, and Joly-Lowdermilk said the program’s administrators hope to expand the Spanish version soon.

BU’s Center for Psychiatric Rehabilitation and the Ruderman Family Foundation, a philanthropic group, created a thorough leave-of-absence guide for students. Available free online, the guide offers advice and functions as an interactive workbook on how to talk about a leave with professors and administrators on campus as well as with family and friends. It also includes a list of resources and contacts like those in financial aid and disability services offices, who may be able to help students understand the impact of a leave and how best to handle it.

While on leave, students should maintain their healthy relationships and establish their support system, the guide suggests, and keep up their executive functioning skills so that their eventual return to the classroom isn’t a shock to their systems. The guide also urges that they get the treatment they need for their mental health conditions, and do things that bring them hope and joy.

And some sort of productive activity helps, said Nance Roy, chief clinical officer at the Jed Foundation, a nonprofit organization that advocates for young adult mental health.

“The last thing you want is for a student to come back prematurely and then go out again.”

Nance Roy, chief clinical officer, Jed Foundation

“It doesn’t need to be like a rocket science job. We don’t care if it’s volunteering somewhere or working at a gas station, it doesn’t matter,” Roy said. “It’s more for the students to get a sense of confidence that they can re-engage in the real world.”

There are also guides for students advocating for better and clearer leave of absence policies on their campuses, and for professors and administrators who are helping support students through leaves of absence.

Roy said it’s essential for colleges to have clear policies on leaves of absence to ensure that students know exactly what is expected of them and what kind of documentation they need and from whom. It’s also important that they don’t return until they are ready.

“The last thing you want is for a student to come back prematurely and then go out again,”

Roy said. “I have seen that happen, and it’s devastating to the student. So, we really want to applaud their wisdom in taking time away.”

Lynch, who took seven years off from school before she attended the Fountain House College Re-Entry program, still relies on the support she gets from her coach there.

After Lynch completed the program in 2019, her coach helped her negotiate with Mount Holyoke to finish her final credits locally, at the City University of New York. And her coach helped her advocate for accommodations — extra time to complete assignments and exams — and set up weekly meetings at the writing center.

After she successfully completed the last two courses she needed, she finally earned her bachelor’s degree in anthropology in the spring of 2020. In May of 2022, she returned to Mount Holyoke, donning a black robe to finally celebrate her commencement after it was delayed by the pandemic.

Now that Lynch has fulfilled her major goal of graduating from college, she’s considering her next move. Graduate school, maybe, or learning to code.

Whatever she does, Lynch said she feels more able to manage her depression while also pursuing her academic and career aspirations. 

And she will take with her a realization she had on her first day at Fountain House: “Oh my God, I’m not alone. I’m not the only person struggling with this.”

If you or someone you know is in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

This story on mental health leaves of absence was produced by The Hechinger Report, as part of the project “Supporting students: What’s next for mental health,” in collaboration with the Christian Science Monitor and the Education Labs at AL.com, The Dallas Morning News, the Fresno Bee, the Post & Courier and The Seattle Times. Sign up for the Hechinger newsletter.