Why most Americans can’t get mental health care as easily as Sen. John Fetterman

In 2023, it’s unconscionable that we’re forcing people to choose between their paycheck and their health.

But it also raised the question: Do everyday Americans have the ability, legally and practically, to take a weekslong pause from their work to seek care during a mental health crisis?

Most workers can’t take the time off

More often than not, workers face roadblocks to long-term mental health treatment, public health and labor law experts told Grid. Only 1 in 5 working Americans is eligible for extended paid family and medical leave. Fewer than half of U.S. workers qualify for unpaid emergency leave.

Extended health leave “tends not be [available to] people who are hourly wage, or people that kind of work a bunch of jobs and show up at all of them to keep their family having food on the table,” said Jessica Gold, a psychiatrist and assistant professor at Washington University in St. Louis. “In those situations, it’s really hard to take any time off ever.”

The stigma of acknowledging mental illness

For the few working Americans who can access such benefits, the persistent stigma around mental health issues may dissuade them from using it in a crisis. “People often want me to write that their hip pain from 10 years ago is the reason that they need time off instead of depression,” said Gold. “Because they don’t think that people understand it as much and they think that people judge it.”

Labor Secretary Marty Walsh acknowledged widespread misunderstandings and stigma surrounding mental health leave at an event this month celebrating the landmark law’s 30th anniversary.

“We need to reaffirm our commitment to implement and enforce, raise awareness about rights, end stigma, about mental health and taking leave,” Walsh said.

“While John has experienced depression off and on throughout his life, it only became severe in recent weeks,” read the statement, shared on Twitter by his wife, Gisele. “After examining John, the doctors at Walter Reed told us that John is getting the care he needs, and will soon be back to himself.”

Lawmakers enjoy special treatment for health concerns

Access to medical and mental care may be closer at hand for federal lawmakers than many members of the general public.

Benjamin Miller, a psychiatrist and mental healthcare access advocate, praised Fetterman for setting an example and helping confront the stigma around seeking mental healthcare. But for most American workers, the logistics of getting mental healthcare can be a complicated process involving insurance companies and multiple care providers, he said.

“We know that most folks with health insurance are several times more likely to pay out-of-network prices for their mental healthcare,” Miller said. “We also know that access remains problematic for most Americans, with various studies showing the average wait times ranging from weeks to months. They will also tell you that taking time away from work, especially when you have to navigate multiple providers, can be frustrating.”

Overall, the main barrier most Americans face to accessing mental healthcare remains lack of paid leave, said Dana Bolger, staff attorney at A Better Balance, a nonprofit advocacy group focusing on workplace issues.

“Most Americans do not have a right to job-protected paid leave to address their own physical or mental health needs,” she said. “That’s because in the U.S. there is no federal law guaranteeing workers paid family and medical leave. There’s not even a federal law entitling workers to a single day of paid sick time.”

Low-wage, part-time workers fare worst

The vast majority of low-wage workers do not have access to paid leave from their employers for mental or physical healthcare, Bolger said.

“I hear from workers who can’t afford to take time off to go to therapy appointments, let alone take weeks or months of leave to seek inpatient treatment or recover at home,” she said. “That’s a travesty, and in 2023, it’s unconscionable that we’re forcing people to choose between their paycheck and their health.”

Still, experts said there are some signs that the stigma around mental healthcare is slowly eroding and that policy is beginning to evolve with it. Some states have enacted legislation recently granting stronger healthcare leave protections than exist under federal law.

Gold, of Washington University, said the way society reacts to Fetterman’s story will be a litmus test of how far America has progressed in its views on mental health treatment since then.

“It’s something we have to kind of watch play out,” she said. “But I think people don’t understand mental health enough to know that you can recover and that people can do their jobs just fine.”