The problem addressed in this comparative case study was to understand the creation and implementation of the medical withdrawal policy and differences of the return from withdrawal policies in the University State System in the context of students with severe and persistent mental illness. This study focused on two specific institutions in the University State System with unique institutional characteristics and distinct policies for returning from medical withdrawal: the University State -- Brown Hedge and the University State -- Blue Bluff. The secondary purpose of this study was to understand the impact of micro, mezzo, and macro factors on policy development and implementation. The findings identified the opportunity to connect medical withdrawal and universal design to reimagine medical withdrawal and reentry policies. The study also identified the collegiate stress experienced by students and the state of wellness for students, staff, and faculty. The final finding described the primary driver of the current state of medical withdrawal policies as financial due to the rise of the neoliberal university and the shift to students as consumers. Recommendations are provided for post-secondary education practice to address best practices in medical withdrawal policies and practices, challenges with campus and community providers, and financial implications withdrawal policies. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]