Does FMLA Cover Mental Health? A Complete Guide for Therapists and Their Clients

Tyler, a writer in his late 20s, was going through a new round of panic attacks. At work, he’d suddenly find himself gripped by debilitating fear. This understandably interfered with his ability to work.

Luckily for Tyler, he worked at a company that was required by law to offer family and medical leave. The 1993 Family and Medical Leave Act was established for people like Tyler and their families who have to contend with health diagnoses. This includes mental health diagnoses like panic disorder and others (which we discuss in detail below).

FMLA promises that if you or a family member need to miss work due to health reasons, you can keep your job and insurance benefits while you attend to your health.

So, how does FMLA cover mental health if you or a family member develops a mental disorder? And if covered, how do you go about getting them?

Understanding FMLA

The Family and Medical Leave Act (FMLA) is a U.S. federal law enacted in 1993 to help employees balance their work and family responsibilities by allowing them to take reasonable unpaid leave for certain family and medical reasons.

It seeks to support workers who find themselves in situations similar to Tyler's, needing time away from work to deal with serious health conditions without fear of losing their jobs.

Key Provisions of FMLA:

• Eligibility: To be eligible for FMLA leave, employees must work for a covered employer, have worked for the employer for at least 12 months, and have clocked at least 1,250 hours over the past 12 months.
• Coverage: FMLA applies to all public agencies, all public and private elementary and secondary schools, and companies with 50 or more employees.
• Entitlement: Eligible employees are entitled to up to 12 work weeks of leave in a 12-month period for, among other reasons, the serious health condition of the employee or a family member, including those related to mental health.

The Role of FMLA in Mental Health:

Mental health issues can significantly impact an individual's ability to perform at work. Recognizing this, FMLA covers leave for serious mental health conditions that make the employee unable to perform their job functions.

This coverage is not limited to the employees themselves. It also extends to situations where an employee needs to care for a family member with a serious mental health condition, such as depression.

A mental health condition qualifies as a "serious health condition" under FMLA if it requires either inpatient care or continuing treatment by a healthcare provider.

This definition encompasses a wide range of mental health issues, from severe anxiety and depression to more complex disorders such as bipolar disorder or schizophrenia. More on this below.

How Mental Health Is Recognized Under FMLA:

• Inpatient Care: This includes any overnight stay in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment in connection with such inpatient care.
• Continuing Treatment by a Health Care Provider: This can involve a period of incapacity lasting more than three consecutive, full calendar days and any subsequent treatment or period of incapacity relating to the same condition. This includes treatments that require absence from work, school, or other regular daily activities for more than three days and that involve continuing treatment by (or under the supervision of) a healthcare provider.

By covering mental health conditions, FMLA acknowledges the critical need for employees to take the necessary time for treatment and recovery without the added stress of job insecurity.

For individuals like Tyler, understanding these provisions can be the first step towards managing their condition while maintaining their professional life.

What Mental Health Conditions Does FMLA Cover?

For your leave to be covered by FMLA, your situation must meet one of the conditions above. As long as one of these conditions is met, FMLA will cover the following.

Major Depressive Disorder

FMLA covers periods of intense depression that incapacitate an individual from working, necessitating ongoing treatment by a healthcare provider to manage symptoms and improve functioning.

Severe Anxiety

If anxiety is interfering with your or a family member's ability to function, FMLA will cover it.

Postpartum Depression

Acknowledging the severe impact it can have on new mothers, FMLA covers leave for treatment and recovery from postpartum depression, including therapy and medical care.

Post-Traumatic Stress Disorder (PTSD)

For individuals or family members dealing with PTSD, FMLA supports taking time off for ongoing treatment, such as therapy sessions, to address the condition effectively.

Panic Disorder

FMLA covers individuals with panic disorder, allowing them to take necessary leave for treatment and recovery. This includes time for therapy sessions, medical consultations, and other treatments essential for managing this condition. It acknowledges the critical need for mental health support, ensuring job security while addressing health needs.

Obsessive-Compulsive Disorder (OCD)

OCD can severely disrupt daily living and work capabilities. FMLA allows individuals to take time for intensive therapy sessions or hospital stays required for managing their condition.

Bipolar Disorder

This condition often requires regular monitoring and treatment adjustments. FMLA can provide the necessary time off for both inpatient care during severe episodes and ongoing outpatient treatment.

Leave for a Spouse Dealing with Substance Use

FMLA covers leave for caring for a spouse undergoing treatment for substance use, recognizing the essential support needed during rehabilitation programs or regular therapy sessions.

Anorexia Nervosa

When the disorder significantly impacts one's physical health and ability to function, requiring consistent medical supervision or therapy sessions, FMLA coverage is applicable.

Schizophrenia

Given its profound impact on perception and behavior, schizophrenia may necessitate periods of hospitalization or consistent treatment to maintain employment functionality, covered by FMLA.

Dissociative Disorder

This disorder can lead to significant distress and impairment, requiring specialized treatment. FMLA leave includes time for hospitalization or regular therapy necessary for managing symptoms.

Military Caregiver Leave under FMLA

Allows eligible family members up to 26 work weeks of leave in a single 12-month period to care for a covered service member with a serious injury or illness. This applies if the service member is the spouse, son, daughter, parent, or next of kin of the employee. This is significantly longer than the standard 12 weeks of leave provided under regular FMLA provisions.

Traumatic Brain Injury (TBI)

TBI, which is common among service members, can lead to significant cognitive, physical, and emotional challenges. FMLA leave allows for the necessary time off for medical appointments, therapy, and rehabilitation services.

By covering these conditions, FMLA ensures that employees do not have to choose between their job security and their mental health or that of their family members. This act acknowledges the importance of addressing mental health with the same seriousness as physical health, providing a lifeline for those in need of time to heal and manage their conditions.

Navigating FMLA for Mental Health

Once you've established that your or your family member's mental health condition is covered under FMLA, the next steps involve understanding how to properly request leave and what documentation might be required.

Here's how you can navigate the FMLA process for mental health conditions, ensuring that you can take the necessary time off while keeping your job and benefits secure.

Advanced Notice and Communication

• Provide Notice: When possible, provide your employer with 30 days' notice of your need to take FMLA leave. If the need for leave is unforeseen, notify your employer as soon as possible.
• Clear Communication: While you're not required to share your or your family member's diagnosis, you do need to communicate the reason for your leave clearly enough that your employer understands it falls under FMLA.

Documentation and Certification

• Medical Certification: You may be required to provide medical certification from a health care provider verifying the serious health condition. This documentation should include the date when the condition commenced, its expected duration, and a brief statement as to how it makes you unable to perform your job functions.
• Privacy: Your employer is obligated to maintain the confidentiality of your medical records and information. Such information must be stored separately from regular personnel files.

Employer Responsibilities and Employee Rights

• Job Protection: FMLA leave is job-protected, meaning you must be reinstated to your original job or an equivalent position with no loss in benefits upon return from leave.
• Health Insurance: Employers must maintain your health insurance under any group health plan on the same terms as if you had continued to work.

Dealing With Confidentiality

One of the biggest concerns for employees taking FMLA leave for mental health reasons is confidentiality. Rest assured, FMLA has provisions in place to protect your privacy:

• Employer’s Duty: Employers are prohibited from disclosing any medical information about your FMLA leave. They are also restricted from retaliating against you for taking FMLA leave.
• Confidential Records: All medical records and documents related to FMLA leave must be kept confidential and stored separately from the usual personnel files.

Employer's Rights and Limitations

While the FMLA provides strong protections for employees, it also sets certain boundaries:

• Verification: Employers have the right to ask for a second or third opinion on the medical certification (at the employer's expense). However, this must be done respectfully and within reason, without causing undue delay or invasion of privacy.
• Intermittent Leave: For mental health conditions, FMLA leave can be taken intermittently when medically necessary. Employers may require a medical certification for intermittent leave, but they cannot demand excessive details.

When seeking FMLA, understand your rights, provide the necessary documentation, and maintain open, honest communication with your employer.

With the right approach, you can take the time needed to focus on mental health recovery, secure in the knowledge that your job and benefits will be waiting for your return.

Addressing Potential Challenges When Seeking FMLA Leave for Mental Health

Unfortunately, FMLA leave for mental health reasons can come with its set of challenges and concerns. Awareness and preparation can help mitigate these issues, ensuring your rights are protected while minimizing stress during the process.

Overcoming Stigma

• Stigma around Mental Health: Despite growing awareness, the stigma surrounding mental health issues persists. Employees may fear judgment from colleagues or worry about negative perceptions affecting their career progression.
• Confidentiality is Key: Remember, FMLA requires employers to keep your medical information private. Discussing your leave needs without disclosing specific medical details can help maintain professionalism and privacy.

Documentation and Proof

• Obtaining Documentation: The need for detailed medical certification can seem daunting. Establish a good line of communication with your healthcare provider to ensure they understand the FMLA requirements and can provide the necessary documentation on time.
• Dealing with Requests for Additional Information: Employers may legally request additional documentation if the initial medical certification is incomplete or insufficient. Be prepared to facilitate communication between your healthcare provider and your employer to satisfy documentation requirements.

Employer Pushback

• Understanding Your Rights: Some employers might be unfamiliar with FMLA regulations or hesitant to grant leave, especially for mental health conditions. Familiarize yourself with FMLA rights and responsibilities to advocate for yourself effectively.
• Seeking Support: If you encounter resistance or retaliation for requesting FMLA leave, consider seeking support from HR, a legal advisor, or the Department of Labor's Wage and Hour Division, which enforces FMLA.

Planning Your Return to Work

Taking FMLA leave for mental health is a significant step towards recovery, but it's also important to plan for a smooth transition back to work.

• Stay in Communication: Maintain an open line of communication with your employer about your leave status and anticipated return to work date, within the bounds of your comfort and privacy preferences.
• Request Accommodations if Needed: Upon returning, if you still need accommodations to perform your job due to your or your family member's mental health condition, you may request reasonable accommodations under the Americans with Disabilities Act (ADA).
• Ease Back Into Work: Consider discussing phased return-to-work options or flexible scheduling with your employer if coming back full-time immediately seems overwhelming.

Alternatives and Additional Protections

In some cases, you or your employer may not be covered by FMLA, or you may require additional support beyond what FMLA provides.

• Americans with Disabilities Act (ADA): For those not covered by FMLA or in need of accommodations upon returning to work, the ADA may offer additional protections. The ADA applies to employers with 15 or more employees and can provide accommodations for mental health conditions.
• State and Local Laws: Some states and municipalities have enacted their own leave laws, which may offer additional benefits or cover smaller employers not subject to FMLA. One example of this is CFRA in California.
• Company Policies: Beyond legal requirements, some employers offer more generous leave policies or mental health benefits. Review your employee handbook or consult HR for more information.

Be sure to take steps proactively when seeking FMLA leave. This will help you manage your mental health needs while maintaining your career and livelihood.

What if I Don’t Return to Work After My Leave?

The decision not to return to work after taking FMLA leave for mental health reasons is a significant and often complex choice.

It can be driven by many factors, including the realization that your current job is not cnducive to your mental health, or perhaps your condition requires a longer recovery period than initially anticipated.

Here are some considerations and potential implications of this decision:

• Health Insurance: Typically, if you do not return to work following FMLA leave, your employer may require you to reimburse them for the cost of any health insurance premiums they paid on your behalf during your leave. This is contingent upon you not returning due to reasons other than a continued serious health condition or other circumstances beyond your control.
• Job Protection: FMLA offers job protection while you're on leave, but this protection ends once your FMLA leave is exhausted or you decide not to return. Your employer is not obligated to hold your position open indefinitely or reinstate you if you choose not to come back after your leave period concludes.

If this is something you’re considering, be sure to consult with your healthcare provider. Ask them about disability benefits as well if you think they may apply, such as in the case of debilitating depression. Also, keep open lines of communication with your employer, and get help from an attorney if you feel there may be any issues.

Lastly, we recommend that you take your financial situation into account when deciding if you’ll return to work or not. Lacking income can place an added burden on your mental health.

Don’t make this decision lightly or by yourself. Get all the help you need, so these problems don’t balloon into something that adds stress to your life.

For Therapists: How You Can Support Your Clients

Therapists play a critical role in supporting clients through their FMLA journey, from identifying when a mental health condition may qualify for leave to assisting with the documentation process.

By sharing this guide, you provide clients with valuable information that empowers them to make informed decisions about their mental health and employment.

• Documentation Support: Offer guidance on the type of medical information required for FMLA leave and assist in preparing the necessary documentation.
• Advocacy and Education: Educate clients about their rights under FMLA and the ADA, and encourage open dialogues with employers about their needs.
• Ongoing Support: Provide continued support and therapy during their leave, helping clients address their mental health challenges and plan for their return to work.

You can also help a therapy client on FMLA leave use their OON benefits with Thrizer. See how we automate the reimbursement process and save you an average of 2 hours every week with our recorded demo.

Embracing FMLA Leave and Finding Support

As Tyler said, “Your mental health matters more than your job. Don't live to work. Listen to your mind and body; if it's telling you something is wrong - fix it; don't run it into the ground.”

In reading this article, you’ve taken a big step towards understanding and accessing your FMLA benefits. To summarize, here’s what you get with FMLA and how it applies to your mental health.

• Job Protection: The cornerstone of FMLA is its ability to protect your job, allowing you to take necessary time off while ensuring that your position or an equivalent one awaits your return.
• Insurance Benefits: Your health insurance continues under the same terms as if you were working, providing crucial support for ongoing treatment and care.
• Legal Protections: FMLA provides a legal framework that protects employees from being penalized for taking leave due to serious health conditions, including mental health issues.

For employees or their family members wrestling with mental health issues, FMLA offers a much-appreciated path forward. 

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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.