What to know about calling out sick for mental health reasons

“I was worried that my boss, who’s in his fifties, would see me as a ‘special, fragile, millennial snowflake’ who wasn’t committed to my job,” journalist and podcaster Molly Woodstock told me. They wanted to shift their work hours to accommodate a therapy appointment. Though Woodstock knew it was “a super reasonable and necessary request,” they were still afraid of having that conversation.

As a writer and trainer on disability issues—particularly mental illness—I hear these sorts of stories all the time.

Employees across industries have a lot of questions: Can an employer insist I tell them why I need time off, or ask me for a doctor’s note? Will I be passed up for promotions if I disclose a mental illness? Can they fire me for taking “too many” days off?

Here’s what you should know when navigating mental health in the workplace:

What legal protections do I have?

Laws vary by state, and policies vary by employer. Federally, there are some guidelines—but if your employer has any, they’re likely more generous than the federal ones. There are no federal limitations, for example, to what an employer can ask when you call out sick, unless you’re covered by the Americans With Disabilities Act.

The ADA prohibits employers from asking invasive questions about diagnosed ADA-protected conditions, which includes some mental health illnesses. That said, not only are many mental health conditions undiagnosed for a variety of reasons; requesting an ADA accommodation does require you to disclose your mental illness to your employer—for many workers, a difficult proposition.

The law allows employers to require a doctor’s note to “prove” an illness—even if, as is the case with a common cold or, often, mental health conditions, just staying home and resting is the best medicine. The law also doesn’t prevent an employer from denying a sick leave request or implying that coming to work regardless is expected.

What if disclosing my mental health diagnosis changes how I’m seen at work? Can I get fired?

Unfortunately, it’s possible. There aren’t legal protections against supervisors seeing mental illness as a sign of weakness, or employees losing rapport with colleagues or supervisors who may have bias. As such, silent suffering is the standard course of action for many. That’s especially true if you fear getting fired—which is legal for almost any reason in the U.S., including for calling out sick.

Morgan, whose name has been changed for privacy reasons, shared their struggle to navigate this double bind: “I was burning out fast and felt myself and my work slipping. But I didn’t have any sick days left.” Their employer meticulously tracked days off, and they were afraid of losing their job. “Sometimes I would pay to go to the doctor, just so I could get a doctor’s note [and] have a legitimate excuse.”

Because of the stress, they were eventually hospitalized and lost their job. But it doesn’t always go this way. I’ve heard frequently that workers are surprised by how supportive their employers are once they know what’s going on.

How do I request time off for mental health?

Regardless of workplace mental health initiatives or wellness benefits offered, requesting a day off for mental health reasons typically requires a potentially awkward one-on-one conversation with your supervisor, which may still be a massive barrier. But it’s usually a better idea than suffering in silence or faking a less-stigmatized illness like a cold.

Generally, being brief and direct is your best option. You may feel tempted to give more details than are necessary, but most of the time your employer’s main concern is that your work is still going to get done. All they really need to know is that you’re going to miss work because you’re “not feeling well” and when they can expect you back. If they ask you more questions, it’s okay to be vague. And if you do have a diagnosis, you can just say “I have an ADA-protected condition” and leave it at that.

In Woodstock’s experience, the conversation actually ended up going well. “Even though it felt weird and scary, it worked out,” they said. “Honesty ended up being the best policy.”

Is the landscape shifting for mental health in the workplace?

While many companies are beginning to incorporate mental health into their policies, stigma remains—and usually has to be addressed from the top. Other than for ADA-protected reasons, it’s essentially up to employers to decide whether and how to provide staff with mental health support.

I spoke with Eskedar Getahun, chief of staff at PushBlack, a nonprofit media outlet for black Americans, where I’m a digital content editor. Getahun says when she first started working in nonprofits, the idea of taking a mental health day was not common. “I wasn’t discouraged from it, per se . . . but you’re so committed to a cause.”

The struggle to open up about mental health in the workplace is partly because of American work culture, and it can be even worse in nonprofits. In Getahun’s experience, because the “issues were so big and resources were so small,” it seemed like there was no time for staff to relax or recharge. “It wasn’t something people talked about.”

She wants to talk about it. Though it was already policy, when Getahun joined PushBlack she immediately made it more explicit to all staff that taking a “mental health day” was not only acceptable but encouraged.

She and a growing number of organizational leaders recognize that it’s in every company’s interest to have healthy, productive employees, and not just because it’s the right thing to do; the World Health Organization estimates that every dollar put into supporting employee mental health is returned fourfold in productivity.

Can my company incorporate supportive mental health policies?

Even if a company wants to change, they may not know how. Only 25% of managers in the U.S. have been trained in referring employees to mental health resources. It may end up taking advocacy on the part of employees to shift things.

What could you recommend to your supervisor? Other than making policy around “mental health days” explicit, Getahun sees many different ways companies can support their employees. Employee Assistance Programs, or EAPs, can help staff manage mental health at work without having to disclose anything to their immediate supervisor. Employers can make sure their health care plans include mental health coverage. The Center for Workplace Mental Health also maintains a host of resources for employers.

Many companies are also incorporating “wellness” into employer-provided benefits such as yoga classes, gym memberships, and on-site massage. While these kinds of benefits are a net positive, they don’t necessarily reduce stigma—and can’t replace the sometimes necessary step of taking time away from work to rest, recuperate, or visit a mental health professional.

Abeni Jones is an artist, writer, and educator based in Oakland, California, who specializes in mental health, disability justice, race, and gender.