Effect of Health Issues on Dormitory or House Residence

As a residential college, Harvard takes seriously its obligation to support the well-being of all its students. This charge involves not only meeting to the greatest degree possible the needs of students whose continued residence may require reasonable accommodations in physical space or other arrangements, but also safeguarding the right of all community members to be free from undue disruption in their academic and residential lives. In a residential college, an individual student’s medical illness or behavioral difficulties affect not only the individual, but also may affect others in the community. How these issues may affect a student’s enrollment is discussed elsewhere in this Handbook (see Involuntary Leave of Absence). The principles of consultation outlined here are based on the central importance of preserving suitable living arrangements for all residents, while recognizing that each situation is different, and that fundamental principles, rather than ironclad rules, must govern consultation and decision-making on residential life.

Responsibilities of Health and Counseling Services

Medical care and medical decision-making are the province of clinicians. Thus, in consultation with patients, clinicians recommend hospitalization, arrange procedures, prescribe medications, conduct psychological evaluations, and recommend and implement ongoing treatment. Harvard University Health Services (HUHS) preserves the rights to privacy and confidentiality of students under their care, communicating with others about students only with those students’ knowledge and consent, except as noted elsewhere (see the section on Confidentiality and Consent).

As student health and counseling services, HUHS also acts occasionally as consultants to the College, advising College officers about individual students’ needs, ordinarily with students' full knowledge and consent. Two situations that routinely call for close coordination and consultation between HUHS and the College involve relief or accommodations for students with difficulties, and leave of absence considerations. A student with a medical illness or exhibiting disturbing behavior that affects functioning may need professional evaluation of the condition to determine the appropriateness of temporary or ongoing arrangements, relief or exception to academic requirements, or accommodations, until adequate functioning is restored. In response to a request from a student’s Allston Burr Resident Dean or Resident Dean of Freshmen or the Accessible Education Office (AEO), HUHS clinicians may evaluate a student’s condition and make recommendations to the College, without disclosing non-relevant information they may know independently about a student’s medical or mental health condition.

College Responsibilities

The College, in consultation with the affected student, determines whether an injured or ill student, or a student exhibiting disturbing behavior, may continue in residence, and whether he or she may return to residence after a short or longer-term absence due to accident, illness, or behavioral disturbance. In situations where a student’s medical illness or behavioral disturbance raises concerns about the feasibility and appropriateness of his or her residence in a dormitory or House, the College values the expert advice of HUHS or Bureau of Study Counsel clinicians and AEO in reaching its informed decision on the student’s remaining in or returning to the College residence.

Questions about a student’s residence (as opposed to enrollment) most often arise after a significant illness or injury that requires short or longer-term follow-up care, but may also be prompted by situations in which a student seriously disrupts others in the residential community, or requires sustained services or monitoring beyond the capacity of a college to provide or beyond the standard of care that can be expected of a college health service. Such situations include—but are not limited to—the following:

In such circumstances, students may not require hospitalization for clinical reasons, but the level of care and accommodation essential to their stabilization may exceed the physical resources or the appropriate staffing responsibilities of a residential college and/or the standard of care that a college health service can be expected to provide.

Procedure for Notice and Consultation

In such circumstances, and ordinarily with the student’s permission, clinicians at HUHS or, if the student has been treated elsewhere, clinicians at other facilities or in private practice—will consult with the appropriate officers of the College. Depending on all of the relevant circumstances, such consultation may be initiated either by appropriate officers of the College or by clinicians at HUHS. Notice by HUHS that a student has been hospitalized or treated in an emergency department of an area hospital may prompt the College to begin a process of consultation, through which it will decide whether and under what circumstances the student may continue in or return to dormitory or House residence (see the section on Confidentiality and Consent). The College may also independently decide that, based on its observations or other information it has about a student, it should initiate the process of consultation with HUHS clinicians, and ascertain whether that student has been hospitalized or treated by an emergency department. Consultation will be focused upon general information regarding concerns raised by the student’s condition or behavior and requirements for continued care, in order to facilitate the College’s decision about the student’s capacity to maintain residence. Neither the student’s medical nor mental health record will be available to officers of the College. College officers, who may consult with other affected students and responsible staff (only as necessary and in accordance with respect for the individual student’s right to privacy), will then determine whether it is appropriate for the student to continue in or return to residence.

An important consideration in the College’s decision whether a student may continue in or return to residence is the impact of the student’s presence on the community. The College regards as unreasonable the expectation that roommates, suitemates, friends, or residential staff will take on health care responsibilities for other students. Therefore, the College will consider unacceptable any return-to-residence plan that requires other students to monitor a student’s condition or provide care. In many circumstances, HUHS routinely makes Stillman Infirmary available to a student who has received hospital-level emergency care or who is being discharged from an area inpatient facility. This use of Stillman Infirmary is time limited and short term only, as a means to facilitate the student’s rapid and appropriate transition back to residence. Stillman Infirmary cannot serve as a rehabilitation residence for students whose recovery will be protracted.

Any student may refuse to allow consultation between his or her clinician(s) and officers of the College, but a refusal to allow consultation will not prevent the College from meeting its obligation to reach a decision regarding a student’s return to or continuation in residence. In some circumstances, the level of care recommended by clinicians may cause the College temporarily to change a student’s place of residence or to deny residence, if in the judgment of College officers necessary and recommended care cannot appropriately be provided in a student residential setting or is beyond the capacity and purpose of the College to provide. HUHS may make the Stillman Infirmary available to students who are able to meet their academic obligations but are temporarily unable to reside in a dormitory or House.

Since appropriate residential accommodations and follow-up treatment take time to arrange, students who have been hospitalized should expect that consultation between clinicians and officers of the College will need to occur at least twenty-four hours prior to a student’s anticipated return to residence. Both clinicians and College officers will make every effort to resolve questions promptly and, in case of disagreement, to discuss issues immediately and openly with the affected student. Ordinarily, consultation will occur between the student’s attending clinician and the student’s Resident Dean. In the event of disagreement, the clinician, the Resident Dean, or the student, may ask that the appropriate Chief of Service at HUHS, the House Master, the Dean of Freshmen, or another senior College official designated by the Dean of Harvard College be involved. While HUHS clinicians and officers of the College will endeavor to respect the wishes of students regarding treatment recommendations and residential arrangements, the final determination about residence in Harvard housing will rest with the Dean of Harvard College.