On a June day after the 2021 spring semester, the 20-year-old college student swallowed a bottle of pills at her off-campus apartment.

As she slowly woke up at the emergency room in New Haven, Conn., one thought overwhelmed her: “What if Yale finds out?”

She’d heard about other students being forced to leave because of depression and suicidal thoughts, and about the lengthy, nerve-racking reapplication process. It was one reason that the student — whom The Post agreed to identify by her first initial, S., to protect her privacy — told only a few people about her problems.

Three months earlier, a Yale freshman named Rachael Shaw-Rosenbaum had killed herself on campus after contemplating the consequences of withdrawing from the school, her family said. Her death had renewed fierce debate about campus mental health, the way Yale treated suicidal students and the university’s reinstatement policies. Similar controversies have engulfed other universities as student mental health problems soar across the country.

Confined to a room at Yale New Haven Psychiatric Hospital, S. asked her nurses and doctors with growing fear, “Do you have to tell them?”

Yes, they replied. Because she was a student, hospital staffers said, they needed to let college officials know, she recalled. They gave her consent papers to sign for the release of her medical information. She remembers how vulnerable she felt in her thin hospital clothes as she signed the release.

The hospital declined to comment on her account, citing patient confidentiality.

Yale officials quickly set up a Zoom call with S. on a hospital laptop in a small, bare room. On the screen, she said, was Paul Hoffman, the psychologist in charge of student mental health at Yale.

She told him about the rape she’d experienced — but had never reported because she didn’t want her parents to know — and how it had sent her spiraling into suicidal thoughts.

He nodded and took notes. A few days later, he arranged a second Zoom call, with her and her parents.

“We’re going to recommend you take a medical withdrawal,” he told her, she said.

“Do I have to?” S. remembers asking him.

“We’re going to strongly recommend it,” Hoffman replied.

In an interview, Hoffman and other Yale officials declined to discuss Yale’s withdrawal policies or specific student cases. After Shaw-Rosenbaum’s suicide, the university told the Yale Daily News that involuntary withdrawals from Yale are rare and that the majority of students who apply for reinstatement are allowed to return.

For S., leaving Yale meant losing her friends and mentors — people who had kept her afloat during her depression. It meant losing her routine, her lab research, her four-year plan to get into medical school. Losing all the things that gave her purpose, identity and support when she needed them most.

S. had followed the campus debate in the wake of Shaw-Rosenbaum’s suicide. She knew Yale could force her to withdraw if she didn’t leave on her own.

As soon as the Zoom call with Hoffman ended, hospital staffers handed her the cellphone they’d taken when she arrived. She began typing out the email Hoffman had asked her to send. “Good afternoon,” it read. “I am requesting a medical withdrawal.”

In coming months, S. would look back to that moment with anger and regret. It wasn’t what she imagined when she was admitted to Yale, one of the country’s most prestigious universities. She recalled how her family screamed for joy. How special she felt when Yale found out Brown and Northwestern had also accepted her and raised her financial aid to match what they would provide.

“They make you feel like you’re the best of the best, like this bright and shiny thing,” she said. “But as soon as something’s wrong, they want nothing to do with you.”

It had been difficult to get into Yale. She would soon learn how daunting it was for those exiled from the university to return.

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.

Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.

When students are in crisis, their universities often face dueling pressures: the threat of being sued by families if a student dies by suicide, but also accusations of discrimination against those with mental disabilities if that student is forced to leave.

“Sometimes students do need help and do need time off,” said Karen Bower, a lawyer who has represented more than 100 college students forced to take mental health withdrawals. “But colleges are also becoming more aware that they can’t just push students out.”

Yale has been slower than some elite universities to accommodate students who don’t want to leave, critics said.

In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

“It actually made things worse,” said Shayna Sragovicz, 22, a senior. “Because you’re opening up a can of worms in people’s psyche and then not giving them space to work through them.”

In the past year, Yale officials said, the university has hired six more counselors for a total of more than 50. It now allows students to join group therapy sessions in addition to individual counseling. It also added support staffers and launched a pilot program called YC3, where students can drop in for short-term counseling.

The new hires have reduced wait times, Hoffman said. Most students are now able to get therapy appointments within two weeks, he said, and the university hopes to hire more counselors.

“Yale has made a very significant commitment to resources for mental health,” he said.

But many students and former students tell a different story. In interviews, more than 25 described a university flush with money, yet beset by inadequate services and policies that often fail students in crisis.

Some described never hearing back from Yale counselors after seeking help. Others said they’ve learned to hide mental problems and suicidal thoughts to avoid triggering withdrawal policies that they believe are designed to protect Yale from lawsuits and damage to its reputation.

“It’s the exact opposite of what you’d want to happen,” said Miriam Kopyto, 22, a senior and a leader in the Yale Student Mental Health Association.

Several students recounted being given 72 hours or less to leave campus once they withdrew.

Nicolette Mántica was already seeing a Yale therapist as a junior in 2017 when a residential dean learned she periodically cut her arms to cope with stress. That night, the dean invited her to a meeting without telling her why, she said.

She was transported to Yale’s hospital, where college officials told her she had no choice but to withdraw. When she was discharged, a campus police officer escorted her to her dorm room and gave her two hours to pack everything and leave, she said.

“It was just me and my parents throwing all my things into any bag we could find. I was running up and down the stairs sobbing while the officer watched us,” she said. “It wasn’t about helping me. It was about getting rid of me.”

Seven months later, in the middle of applying for reinstatement, Mantica tried to kill herself.

As she recovered in a hospital in her home state of Georgia, she asked herself why she was so fixated on a university that had abandoned her. She decided to transfer to Northwestern University.

“Why go through all the work and struggle to get back to a place where they didn’t care about me?” she said. “Where I felt like a criminal for struggling with mental health?”

University officials did not respond to questions about their interactions with Mantica, S. or any of the other students quoted in this story.

How to navigate taking a mental health break from college

But many Yale students are desperate to remain at the Ivy League college. Rachael Shaw-Rosenbaum was one of them.

“I have attempted suicide 3 times in the past 3 days and have not stopped thinking about it,” she wrote on Reddit on March 16, 2021. “What do I do? If I go to the hospital again this year, I will be academically withdrawn from my university…”

Rachael had grown up in Anchorage and arrived at Yale in the fall of 2020, hoping to study law and follow the footsteps of her hero, Ruth Bader Ginsburg.

But as an 18-year-old freshman on a campus largely empty amid the pandemic, she felt isolated. When Yale’s student newspaper published a story on freshmen adjusting to the coronavirus, Rachael described moving into her dorm by herself and breaking down in tears.

During her first semester, she called Yale’s crisis hotline and admitted herself into the psychiatric hospital, said her mother, Pamela Shaw.

Rachael managed to finish her classes. But the next semester, alone again in her dorm room, she began grappling nightly with suicidal thoughts, according to her online posts. One of her biggest fears, she said on Reddit, was that being hospitalized a second time would get her kicked out.

On March 18, 2021, Rachael’s boyfriend called campus police because he was worried for her, said her mother. When authorities got into Rachael’s dorm room, they found her without a pulse.

For three days, she lay comatose in a hospital bed, with her mom sleeping beside her. Her mother bathed her and read to her, hoping for some response. Finally, she agreed to have Rachael taken off the ventilator.

The daughter she knew — who once dazzled in debate club and worked passionately with juveniles in Alaska’s justice system — was gone.

S. was discharged from Yale Psychiatric Hospital three months after Shaw-Rosenbaum’s death and eleven days after her own suicide attempt.

Her parents drove up from the family’s home in Philadelphia and helped pack up her apartment. She had asked Yale about staying in New Haven, hoping to lean on her closest friends and continue at her research lab as she worked toward reinstatement. But Yale officials told her she needed to spend that time away.

As a withdrawn student, she was no longer allowed at Yale’s libraries, gyms or extracurricular activities. For her to set foot on campus would now require prior approval of a dean, according to college policy.

She spent her first weeks back in Philadelphia plagued by a sense of defeat.

“I felt so broken,” she said.

Relatives, high school friends and neighbors, who had all celebrated her acceptance to Yale, kept asking what she was doing back at home. On the heels of the sexual assault, she felt like she was hiding yet another shameful secret.

“It’s like I’m lying to everyone. They think I’m this successful student at Yale, but I’m really a failure,” she said one afternoon last spring at a Philadelphia coffee shop near an apartment she was sharing with her brother.

Her life now revolved around the requirements Yale had spelled out for reinstatement.

“As much as I’d like to use this time for renewal and healing, it’s not about that,” S. said as she finished her coffee and began walking home.

Failing to be readmitted was unimaginable. Attending Yale had already been a stretch financially for her immigrant parents and was only possible because of hefty financial aid.

Yale’s administrators had also emphasized to her in emails that she would need to “remain constructively occupied.”

So S. found a lab research job. She signed up for dance classes. She volunteered as a crisis counselor for a domestic violence hotline, drawing on her own experience with sexual assault. She helped out at a nonprofit assisting students from other countries applying to U.S. colleges.

The work and volunteering were meaningful, she said, but they also felt sometimes like a performance. Her relationship with the professors in her two university classes felt similarly calculated, because she knew she’d soon need their letters of recommendation.

Beyond reinstatement, she worried about what future medical schools would think of the withdrawal. Her pre-med adviser at Yale told her that medical schools almost certainly would ask her to explain it.

“I feel so much pressure right now. Like I can’t slip up,” she said. “Like I have to be extraordinary for Yale to remember why they let me in in the first place.”

For days, the essay sat blank on her laptop. She added her name, then a title, “Application for Reinstatement,” but couldn’t go further.

It had taken her weeks to write her first admission essay to Yale, detailing her passion for dance and volunteer work.

This time, however, the prompt was starker: 500 to 750 words explaining her withdrawal, what she’d done with the year off and why she felt ready to return.

But S. was still angry about being exiled from Yale. She kept replaying the conversation she’d had with the officials who insisted she withdraw.

“They never asked what they could do to help with the sexual assault and PTSD. Not a single question about how Yale can support you. They didn’t take into account who I was and what I needed,” she said. “Their only concern was that I leave.”

Now the only remaining signs of her connection to the university were a Yale hoodie, a Yale-emblazoned wallet she’d bought as a freshman and a sticker with the university’s “Y” logo on the back of her laptop.

S. knew all the resentment had no place in her reapplication essay. So it sat blank, until one evening in May, when she banged out the whole thing in a few hours.

She wrote in matter-of-fact language about how she’d sought therapy to deal with the PTSD from her sexual assault. She included a line about her work with domestic violence victims and international students.

“I am extremely proud of myself and my progress,” she concluded. “I feel more ready than ever to be a student at Yale, and I sincerely hope to have the opportunity to do so again.”

A few days after she sent it in, she found herself staring at the “Y” sticker on her laptop and ripped it off. She emptied out her Yale wallet and threw it away. She knew she wouldn’t hear back about the reinstatement committee’s decision for another two months.

“I’ve done everything they asked,” she said. “If the objective truth isn’t enough, if they don’t think I’m worthy, then Yale isn’t where I should be.”

In 2018, researchers at the Ruderman Foundation, which advocates for the disabled, assessed the mental health withdrawal policies at all eight Ivy League schools. No university received a grade above D+, and Yale received an F.

Since then, several Ivy League colleges have reformed their policies, often in response to high-profile lawsuits or deaths. And every Ivy except Yale and Brown has joined a four-year-long program to improve its mental health policies through the Jed Foundation, a nonprofit organization focused on suicide prevention and mental health for teens and young adults.

More than 400 colleges have enrolled in the Jed program, said Nance Roy, the foundation’s chief clinical officer, who also works as an assistant psychiatry professor at Yale.

“I’m not sure why Yale hasn’t joined,” Roy said. “I’ve had conversations with them, and even met with the president and others at one point about it. I don’t think they’re ignoring the issue. But they’re doing their own thing.”

In a written statement, Yale spokeswoman Karen Peart said, “The College engages in frequent evaluation of all its policies in an effort to best serve our students.”

Over the past year, Yale has been under increasing pressure to reform its reinstatement process.

“It’s hard to explain what’s so dehumanizing about it that it’s haunted me for two decades,” said Alicia Floyd, who withdrew after a suicide attempt in 2000 and now works as a doctor. “It’s the betrayal you feel, the violation. Realizing how unimportant you are to this institution that you had such high hopes for. The trauma of how they treated me has outlasted many other issues I had.”

After Shaw-Rosenbaum’s death, Floyd and other alumni created a nonprofit group called Elis for Rachael. They’ve held a campus vigil for suicide prevention and given money and guidance to students navigating reapplication.

They’ve also demanded that Yale administrators change their approach to students in mental crisis.

Instead of the all-or-nothing proposition of withdrawal, they say students should be given options such as reducing course loads or attending part-time.

Many schools have stopped forcing students to withdraw and have lowered barriers for them to return. Three years ago, Stanford University settled a class-action lawsuit by agreeing to give students greater say in whether to take a leave of absence for mental health reasons. And if students choose to remain, the university now provides disability accommodations. Last year, Brown University agreed to changes following an investigation by the U.S. Justice Department.

At Duke University, students who take time off now have an office dedicated to supporting them while they are away. Boston University’s Center for Psychiatric Rehabilitation created a program and a 48-page guide to help college students navigate leaves of absence.

Yale’s activists note that students forced to withdraw lose their student health insurance and access to counseling when they need those benefits most.

“My big question was how do I get therapy,” said Alicia Abramson, 22, a current student who withdrew in her sophomore year while struggling with depression and an eating disorder. “Once you’re out, they cut you off from everything. I couldn’t afford therapy on my own. My family didn’t believe I had mental problems at first and didn’t want to pay for it. I had to have a breakdown and almost kill myself before I got the help I needed.”

She and other students say that despite increased staffing, Yale’s mental health services still lag behind demand.

Madison Hahamy, the student reporter who’d talked to Shaw-Rosenbaum about her depression for the Yale Daily News, was haunted by her suicide.

“She was so vulnerable and raw with me,” Hahamy said.

Months later, Hahamy found herself struggling as well. In September 2021, she talked to a counselor through the new YC3 program. The counselor asked whether Hahamy ever had suicidal thoughts.

“She was the first person I’d ever told that to,” said Hahamy, now 22 and a junior. “I was crying every single night. I needed help.”

But it took two months and repeated requests for her to get an appointment with a therapist, she said. After a few months of 30-minute sessions every other week, Hahamy stopped going.

“It was so short, it was just making me feel worse,” she said. “Even after everything that happened to Rachael, it’s like nothing changed.”

The email from the reinstatement committee arrived on July 8 in the middle of the night.

S. had decided to take a solo trip to Europe while waiting to hear back from Yale. So it was early morning in the Alps when she read the words: “Congratulations! I am delighted to inform you that the Committee on Reinstatement has approved your application.”

Six weeks later, S. was back in New Haven.

She had been 19 years old the last time she sat in a Yale classroom. Now, she was 21 and feeling like a stranger on her own campus.

Her parents helped her move into an apartment with two close friends. As she unpacked, she came across the white Yale hoodie she’d bought as a freshman. She remembered her sense of wonder and pride back then whenever she wore it.

Several weeks ago — as her new classes began — she tried it on again and was surprised to feel nothing.

The hoodie, hanging in her closet, was now just another piece of clothing.

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 988. You can also reach a crisis counselor by messaging the Crisis Text Line at 741741.

Story editing by Lynda Robinson, photo editing by Mark Miller, copy editing by Gilbert Dunkley, design by Marie Alconada Brooks and Dominic Fisher. Alice Crites contributed research to this report.