QuestionShould you get paid sick days for mental health?
Hopes&Fears answers questions with the help of experts. Today, we ask experts in mental health advocacy, employee rights and public health care if sick days legislation should apply to mental health.
New York City has only recently adopted a policy mandating paid sick days for workers, but there are few other places in the country make that guarantee. And while Americans are still fighting for laws that will protect their jobs when they have the flu, it's even harder to get time off for a mental health problem, even as mental illness reaches epidemic proportions.
In many places, it’s not widely accepted that mental illness is as valid a reason to miss work as purely physical illness. But should it be? And if so, how should it be handled?
We asked experts in mental health advocacy, employee rights and public health care if employers should treat mental illness the same way they treat physical illness when it comes to paid leave.
Deputy Associate Director, Pay & Leave, U.S. Office of Personnel Management
The Federal Government supports employees who may be experiencing mental health concerns and need to take time away from their work responsibilities to seek medical attention. Employees experiencing chronic depression, post-traumatic stress disorder, or other mental health conditions may use sick leave or leave under the Family Medical Leave Act (FMLA) to take time off from work. As outlined in regulation, Federal employees are entitled to use sick leave when he or she receives medical treatment or is incapacitated for the performance of duties by physical or mental illness (Source: 5 CFR 630.401(a)).
The Federal Government also supports employees with a child, spouse, or other loved one facing mental health issues. Federal employees are authorized to use sick leave to care for a family member receiving appropriate treatment for mental illness. For example, an employee is entitled to use up to 12 weeks of sick leave each leave year or up to 12 weeks of leave under FMLA to provide care for a family member with a serious health condition. For purposes of sick leave and FMLA leave, the term serious health condition “means an illness, injury, or impairment, or physical or mental condition” that involves inpatient care or continuing treatment by a health care provider. The regulations explain that various medical situations, including specifically mental illness resulting from stress may be serious health conditions if such conditions require inpatient care or continuing treatment by a health care provider.
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Executive Director, Mental Illness Policy Org
People with poor mental health can work, but most people with the most serious mental illnesses do not work. Only about 10% of those with schizophrenia work full-time, and the number would be much lower is you exclude subsidized employment or jobs that are set aside for people with mental illness. In 30 years of advocacy, I can count on two hands the number of people I know with schizophrenia employed in non-subsidized competitive employment outside arts and mental health fields. So time off is not a big issue.
One widely quoted stat is that lost wages due to serious mental illness cost $193.2 billion a year. From that, we are supposed to take away that if everyone with an untreated serious mental illness were given treatment, they could be put back to work, and those wages wouldn’t be lost. But the truth is, existing treatments are not yet effective enough to return many of the most seriously ill to work. The treatments are barely good enough to prevent some from hallucinating and becoming delusional. Much better meds and treatments are needed. I think our policies should be grounded in science. Until there are more effective treatments, lost wages is not an honest justification for supporting more treatment for the most seriously ill, although it is a reason to spend more on research.
There is a caveat: giving parents or caregivers of those with mental illness time off to tend to all the case management work they have to do is extremely important. Here’s a story: I live in Harlem and went to a Harlem Alliance for the Mentally Ill meeting and tried to tell one mom how to get housing for a SMI (seriously mentally ill) kid. She said, ‘DJ, I can’t make all those calls.' I asked why. She said she didn't have enough minutes on her phone. But even if she did, she said, she makes beds in a hotel and her boss would never let her take the time off to make all those calls. So time off for caretakers is critical. Caring for someone with SMI can be a full-time job.
A notable exception is people with bipolar disorder, who can often be successfully treated and return to work.
Senior Staff Attorney, A Better Balance
At A Better Balance, we believe very strongly in workers having paid sick time to care for health conditions, whether mental or physicals. All the paid sick time laws that have been passed cover mental health. No workers should have to decide between putting food on the table and caring for an illness.
It's been phenomenal to see all the momentum around paid sick time recently. As far as we're aware [mental illness] hasn't been raised as an issue anywhere. Studies show that everywhere paid sick leave has passed it is working well. Workers are benefitting from it, which is why we think we're seeing so many new laws passed.
The exact requirement varies based on each law, but generally you have to be out a certain number of days before you can be required to bring in a doctors note. In most of the laws, it's three consecutive days, but there are some differences. And after those three days, the doctors can't be required by an employer to disclose the reasons why you need leave, just that you do need the time in order to use it for the purposes required by the law.
of people who receive federal disability funds have a severe mental illness.
Vice President for Policy Research, Community Service Society of New York
I'm an expert on sick days, but not a health expert. I was one of the leaders of the campaign that led to paid sick days in New York City. Those cover both physical and mental health. We all know that mental health is exceedingly important. We see [mental illness] every day. We know about how depression and other mental illness that affects people's ability to function in their families and on the job. They need to be diagnosed and treated as much as someone with a physical condition.
We see the impact of mental illness beyond the individual, just the way physical illness affects public health. You don't want someone with tuberculosis riding on the subway or serving you, and you wouldn't want someone with a mental illness who could harm themselves or others out on the job.
When we started working on getting paid sick leave, most middle-class people took it for granted. They thought, 'Doesn't everyone already get it?' It was shocking for people to find that the majority of low-income workers don't get any paid sick time. We made a very strong argument. Do you want the people serving food in restaurants to not have a sick day? Do you want the person squeezed next to you in the subway to have a fever because they can't afford to take a day off or they'll lose their job? It's a necessary basic thing.
Paolo del Vecchio
Director of the Center for Mental Health Services at SAMHSA
Good mental health improves employee productivity and job satisfaction. Sick leave for mental health is as important as other medical leave and a sound return on investment in helping to ensure overall worker health, reduce costs, and improve the bottom line.
Ronald C. Kessler, PhD
McNeil Family Professor of Health Care Policy at Harvard Medical School
Let’s assume that an employer offers paid sick days to workers, and they do it as a benefit both to the worker and to the company. As a benefit to the worker, we have paid sick days for a sprained ankle, the flu, etc. If we’re doing it for the worker’s sake, the value of a day off work is pretty much the same with emotional problems as physical problems. The pain associated with an emotional problem is the same or greater as that associated with a physical health problem.
Some employers could say, “Well, gee, it’s really hard to confirm for sure that a person has a mental health problem. How do we know for sure that it’s a problem? Maybe they’re just being lazy, so we shouldn’t count that.” At least with a physical health problem, you can get a doctor’s note. How do you know someone’s not just going fishing? They could say that they do [have a problem] when they really don’t. Well, it’s the same kind of thing with physical health. You can malinger just as well with a complaint about a physical problem as a mental problem.
You could say, “What if it [mental health problem] goes on forever?” A physical problem might last three days while a mental health problem could go on every day. Employers do have ways of handling that. All employees have a certain number of sick days you can have per year. It depends on the employer; you might get 10 sick days or 12 sick days, and after that you have to go out on disability or not get paid. There are caps on all these things.
When you look at the research that’s done on the effects of mental health problems on work performance, mental health problems are among those that have the biggest impact on work performance—depression, ADHD. If the worker needs time off because of emotional problems, the impact on work performance is probably going to be affected as much or maybe more than if they take a day off for a physical health problem. In terms of paying a full day’s wage for a full day’s work, the emotional problems have as big of an effect on work performance.
Women’s Career Coach and Work-Life Expert
When we need mental health days, it’s because our wellness and mental health need it, and that equates sickness. It equates needing time to restore ourselves, to rest, to balance ourselves. It’s not a “nice to have,” it’s an essential. If we can’t use our sick days for that, and we don’t balance our self and attend to our mental health and get sick—I wrote a whole chapter on this in my book “Breakdown, Breakthrough”—chronic stress leads to chronic illness.
If you’re not allowed to use a mental health day as a sick day, just wait and see how many more sick days will come. It’s about how we define wellness and health. I believe our mind, body, and spirit are inextricably linked, and you cannot have wellness and health if mentally you are coming unscrewed because of the stress of work.
I believe in transparency and I believe in truthfulness, however if we have a yeast infection, we don’t share with our boss that we have a yeast infection. I feel that you call up and say “I’m not feeling well today, and I have to take today off.” And that’s it. You don’t go into how, why, where, when, or what you’re going to do. They don’t need to have that, and it’s your right to not have to share that.
According to the Wolrd Health Organization, by 2020 depression will be the second-leading cause of disability worldwide for people between 15 and 44 of both genders.
Nancy W. Spangler, PhD
Consultant to the Partnership for Workplace Mental Health
People with mental illnesses may have symptoms that occasionally get in the way of their effectiveness or safe performance at work. They may also have treatment-related difficulties that affect their ability to be alert, make complex decisions, or stay focused. So, taking a sick day may help them regroup and return to work at a higher level of functioning.
But all of us experience work days that are more stressful than others, and excessive distress can interfere with anyone’s mental, emotional, physical, and social capacities. For that reason, many workplaces are allowing more flexibility and are providing spaces that allow workers to take a break when needed, stretch or meditate, socialize for a minute, get some physical activity or something healthy to eat, and recharge their physical and emotional batteries. They’re also providing educational and support services that help people with mental concerns earlier and more creatively, and with greater empathy for the challenging issues people face.
The total wages lost to mental illness in 2013.
Additional reporting by Zoe Leverant and Kelsey Lawrence