- Poll of 3,002 employees.
- Illinois employees suffered a loss of $11,352 per person over the course of 5 years due to mental health issues.
- Infographic included.
A nationwide survey highlights widespread confusion around federal protections, fueling fear, silence, and lost income. Revealing a striking gap in awareness around U.S. workers’ legal rights to take protected medical leave for mental health or substance use treatment – a gap that may be driving millions of Americans to suffer in silence at work.
RenaissanceRecovery.com, a nationwide association of addiction and mental health treatment centers, conducted a survey of 3,002 employees examining the financial impact mental health and substance use challenges had on Americans’ ability to earn a living. The study focused on how time off work, reduced hours, or disrupted employment translated into lost income for people dealing with these conditions.
Nationally, 41% of respondents said a mental health or substance use issue had affected their ability to work, and of those, it was estimated that they had lost 16% of their income as a result. At a loss of $10,968 per person over the last five years, that accumulated to $1,151,393,123,529 nationally due to mental health and substance use challenges.
The survey found that mental health or substance use issues in Illinois resulted in a loss of $11,352 per employee, amounting to a total economic impact of $44,553,678,678 statewide.
The findings showed clear differences by state, with workers in Massachusetts experiencing the greatest income disruption, at a loss of $14,050 within the last five years. Comparatively, those in Mississippi suffered smaller financial losses of $7,698.
Interactive map shows the breakdown across America.
The survey also found that fewer than half of workers (46%) know that federal law allows eligible employees to take job-protected leave for mental health or substance use treatment.
At the federal level, the Family and Medical Leave Act (FMLA) guarantees eligible workers up to 12 weeks of unpaid, job-protected leave for serious health conditions – including mental health and substance use treatment. Although FMLA leave is unpaid, some workers may have access to income support through employer short-term disability policies or state-paid family and medical leave programs. These benefits can, in certain cases, be used alongside FMLA to replace a portion of lost wages during mental health or substance use treatment. Understanding what benefits are available – and how they interact – may help workers make more informed decisions about taking leave when they need it. Yet the study found that understanding of the law remains limited. Only 38% of respondents said they were “very familiar” with FMLA, while 27% had heard of it but didn’t know the details, and 16% had never heard of it at all.
That lack of clarity appears to directly influence whether workers seek help when they need it most.
Mental health is still not seen as a “valid” reason to step away.
When asked which situations they believed qualified for protected medical leave, respondents overwhelmingly selected physical health events such as physical illness or injury (31%) and surgery or recovery (30%). By contrast, only 15% believed mental health treatment was qualified, and just 3% recognized substance use treatment as a valid reason for protected leave. Nearly 8% said they didn’t think any of the listed reasons qualified at all.
These misconceptions are especially concerning given how common workplace mental health struggles have become. The study found that 41% of respondents said they had experienced a mental health challenge or substance use issue in the past five years that affected their ability to work.
Despite this, many chose to keep working rather than take formal leave – often out of fear rather than choice.
Fear, finances, and silence at work.
Among respondents who continued working during a mental health or substance use struggle, the most common reasons were fear of job loss (22%), not knowing leave was an option (18%), and being unable to afford unpaid time off (15%). Others worried about harming their future career (11%) or felt their condition wasn’t “serious enough” to justify leave (14%).
When asked about their biggest concern around taking formal leave, losing income ranked highest by a wide margin (34%), followed by fear of being fired or laid off (18%). Concerns about being treated differently afterward, losing health insurance, or being seen as unreliable also featured prominently.
These anxieties help explain why honesty in the workplace remains elusive. More than 56% of respondents admitted they had lied or downplayed the real reason they needed time off, while 43% said a physical illness would feel like the “safest” excuse to give if they needed mental health leave tomorrow. An equal share said they would cite a family emergency.
The hidden cost of “pushing through”.
For many workers, continuing to work through mental health challenges came at a steep personal cost. Among those who did so, 31% reported increased anxiety or stress, 27% experienced exhaustion or burnout, and others cited declining physical health, more mistakes at work, or missed deadlines.
Nearly 61% said continuing to work instead of taking leave made their condition worse, and 42% reported long-term career consequences, including slowed career growth, turning down opportunities, or leaving a job altogether. On average, respondents estimated they lost $10,457 in income due to delayed treatment or ongoing struggles.
Even with these consequences, workplace culture appears deeply divided. While 51% of respondents agreed that workers are encouraged to prioritize mental health, nearly 49% said workers are still expected to cope quietly and keep working. More than half believed someone at their workplace is more likely to be punished than supported for taking leave.
A call for clarity and cultural change.
The findings suggest that improving mental health outcomes at work may depend as much on education and trust as on formal policy.
“What this data shows is that many workers aren’t just struggling with their mental health – they’re struggling with uncertainty, fear, and misinformation,” says Alina Nejadian, LMFT (Clinical Director) of RenaissanceRecovery.com. “When people don’t understand their rights or don’t trust that they will be protected, they delay care, hide their struggles, and often make their situation worse. Clear communication, supportive workplace cultures, and better awareness of existing protections could make a meaningful difference for millions of employees.”
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