Commentary: The Importance of Accommodations in Higher Education

Salzer and colleagues' study ( 1 ) explored several issues related to the Americans With Disabilities Act (ADA) in higher education. In highlighting the importance of this study, I would like first to raise two interesting theoretical questions. What is the justification for accommodating someone with, say, attention problems resulting from attention-deficit disorder or depression but not someone who simply has poor concentration, or for accommodating someone with learning disabilities but not someone with low intelligence? Why is the presence of illness decisive?

Second, Salzer and colleagues' study found that the main reason current students don't seek accommodations is that they feel they don't need them. Would you urge a patient to seek accommodations or would you support her desire to perform without special treatment and to avoid self-identifying as disabled? Should a therapist encourage a patient to take advantage of whatever can help, as many nondisabled people do? Students who seek accommodations have higher graduation rates and better grade-point averages, according to the study. But accommodations may not be the cause; more ambitious students may be the ones who seek accommodations.

Salzer and colleagues' article also highlights areas for future research. First, the study showed that knowledge of accommodations is important to seeking them: people need to know their rights in order to invoke them. One research question is how best to inform students of their rights. Another question is how accommodations are invoked by and benefit different groups of students, such as students with learning disabilities and those with psychiatric illnesses. We need to study how successful each group is with accommodations and how best to advise each.

Another research topic is how best to foster mental health professionals' awareness and active involvement in these issues. Professionals are in a position not only to educate and inform patients but also to provide input on how best to accommodate them. There are currently some good models of what an informed and active clinician can do ( 2 , 3 ). In addition, exploring how to reduce barriers to seeking accommodations is essential. Finally, it will be also be important to examine whether ADA requirements decrease stigma because persons with mental illnesses are experienced by fellow students as successful peers or whether stigma increases because the nondisabled student body resents their being given accommodations.

I want to end on a more personal note. I am myself a "consumer"—a person with schizophrenia who was given "very poor" and "grave" prognoses ( 4 ). I was expected essentially to be unable to live independently, let alone work. Yet I have a very active and satisfying professional life as a chaired mental health law professor. When I was examined for readmission to Yale Law School, the psychiatrist suggested I might spend a year working at a low-level job, perhaps in fast food, which would allow me to consolidate my gains so that I could do better when I was readmitted.

Yet for me, being a student was far less stressful than being a cashier would have been. I had learned to be a student before I became ill. It gave me a great deal of satisfaction. My time was flexible. I could do the work without significant interaction with others (I need time to myself). In short, a menial job for me would have been much more stressful than being a student—so shooting high was actually less stressful than shooting low.

Second, the satisfaction and well-being that come from a job like mine are far higher than what I could have expected without a college education. College accommodations will give people opportunities for more meaningful work, which will make their lives better and benefit society as well.

Not everyone who has the aptitude for college will succeed. But we shouldn't discourage people from trying, and we should explore ways to help them live up to their potential. In that way, recovery and quality of life will increase, to everyone's benefit.

Acknowledgments and disclosures

The author acknowledges the assistance of Dilip Jeste, M.D., Robert Liberman, M.D., and Susan Stefan, J.D.