FMLA for mental health? Difficulty level: Kaiser, Southern California
May 13, 2022 8:12 AM   Subscribe

TL;DR: I desperately need to take FMLA leave with my job sooner rather than later because I'm in a very, very bad emotional state. Kaiser is...unhelpful. What do?

I am at the very end of my rope with an extremely stressful job and a shitty, unsympathetic boss, plus other intense emotional turmoil that is catching up with me. Quite frankly, I feel like I'm losing my fucking mind. My memory is shot, I can't eat or sleep, and I'm hyper-vigilant and reactive to everything, my resting heart rate is through the roof.

It occurs to me to quit outright. However, I would rather just...exist and deflate for a few weeks, even if it's unpaid, and make a more graceful exit when I'm not about to lose it. I have nearly exhausted my sick and vacation time to try to get my shit together.

To that end, I absolutely need to go on FMLA leave. I had an intake appointment with a LCSW this morning with Kaiser, who agrees that I'm a wreck, but apparently is not authorized to sign off on work leave, so they referred me to a psychiatrist.

The earliest I can see the psych is in June. I'm freaking out because I don't think I can keep working in the state that I'm in until then. As a backup, I have another appointment with a rando physician (not my PCP, who is also booked for the next month) on Monday.

So is there anything else I can do? What are, or should be, my next steps? Kaiser was already overwhelming and labyrinthine when I could function - this just feels so impossible now.
posted by anonymous to Work & Money (12 answers total) 2 users marked this as a favorite
First, I'm sorry you're going through this. It sounds incredibly difficult for you. But I think you have more options.

Does your employer allow leave without pay under any other circumstances? In other words, is FMLA your only option? (Note that you'll need to keep your insurance, though.)

Does your employer actually require medical certification for FMLA? (Probably, but worth confirming if you can do so without directly alerting anyone, for reasons that will be apparent in a second.)

As a last resort, telling them you're going on FMLA and then getting them the certification when you can is probably doable. Especially since you think you might be leaving anyway. Basically, you have a statutory entitlement to fifteen calendar days after the employer requests certification to provide it. As a practical matter, they're probably not going to fire you on day sixteen. And if you can get them "incomplete" or "insufficient" certification (which could really be almost any good faith attempt at some of the required information listed in that factsheet), you get another seven days to fix it after the employer rejects it. So either you can try to tough it out until twenty-three days before your appointment (since if you make the request at the end of that day you're unlikely to get the request until at least the next day), or go out earlier and see how long you can push it.
posted by praemunire at 8:44 AM on May 13 [4 favorites]

Can you ask to be on the waitlist for your PCP? And does your PCP hold open appointments that you can call the morning of to book? It might be helpful if you can call or message directly to her or her nursing staff (not the front desk) and explain the situation. In similar situations, that's exactly what happened. And they wouldn't book those slots in advance, I was able to call the next day and say "Dr. Doctor's nurse said I should call and find out if she had any open slots left today to see me." I've probably had to do this 3 or 4 times in the 20 years of seeing her, and I might not be able to get in that day, but could within a day or three of trying each morning. (She now has an NP I can usually get in to see in a day or two, and she will triage it up the chain. Which I actually kinda hate, because I've had more stupid crap be "treated" incorrectly, only to have to get in to see Dr. But her NP has also been able to do more medical administrative work, like paperwork for disability accommodations at my school, and just write it out and have dr. sign off, which really does speed things up.)

Explaining the situation to your PCP will help a lot, especially if you let them know the steps you've taken and that you are working to get into a psychiatrist. In your situation, it meant renewing my FMLA leave with my GP a few times for short periods (I think two weeks to start, another two weeks, then a month?) before I got into a therapist and psychiatrist.

My only word of caution was that I ultimately did not go back to work for a long time, and I struggled with work since, though it's complicated by my late husband's suicide. But I think I needed the time and at the same time, didn't realize being out of work was also impacting my mental health.

Ultimately, I was diagnosed with ADHD because of being out of work, and that contributed to the mental and physical health problems I was having; all the overwork and lack of sleep from compensating for ADHD was not pretty. And I did get back to work shortly after being diagnosed and treated with ADHD, but then everything went off the rails anyway.

I'm not saying you shouldn't do this, because it sounds like you need it. What I am saying is that I am fairly certain at some point I hit not working because I'm not working and thinking I couldn't work because I wasn't working loop and fed into a low grade depression that no one seemed to catch because it was atypical and so I could brighten up situationally. I mean, I come back to the adhd diagnosis and had I gone back to work earlier, would I have ever had a therapist catch it?

I think the point here is not to not take FMLA, but just a cautionary tail to be careful about staying on it due to a vicious cycle starting. Make a plan for returning to work AND managing your mental and physical health, and evaluating what to do if you are not ready. You might not be able to make a fully articulated plan with where you are right now, so it really could involve just putting in calendar that you need to make that plan or check in with someone.

There also is a point relating to your PCP or even a psychiatrist. If you already have a plan in place (even if its a plan to make a plan), your doctor will probably feel better about signing off on temporary leave, and if you have to renew after a short leave, you can say "okay, I've got the broader plan of seeing a psychiatrist, looking for another job, going to the gym to manage mental health x times a week, and seeking to achieve these physical and mental health milestones before returning to current job. I'm still not functioning well enough to return to work because of x, y, and z."

Finally, to getting in to see any provider, going to urgent care at your doctor's clinic MIGHT work, but it will likely be for a shorter gap, like a couple days before you can get some sort of urgent appointment. But it could also get you help getting a referral to one of their psychiatrists and on a waitlist for an earlier appointment.

It is a pain in the ass, especially when you aren't coping with the demands of life well. But my limited experience is this is what and how I would do it in your shoes.
posted by [insert clever name here] at 8:52 AM on May 13 [4 favorites]

I had the physician who was available sign off on my mental-health FMLA because my PCP was booked, this is definitely a thing that can happen. I just asked at the appointment and then sent the HR paperwork to her when I got it. I got referred back to my PCP for ongoing followup after the FMLA case ended.

Getting all the paperwork in order was stressful because I wasn't doing well, but ultimately it went fine and both HR and the physician were helpful and had processes set up to help. Go to the appointment on Monday and tell them what you said here. Also check out whatever information your HR has available so you know contacts and next steps on that side, but try not to worry about it too much. Just take it one step at a time.
posted by momus_window at 9:09 AM on May 13

I am very sorry you have to deal with that system in conjunction with what you are emotionally experiencing; it's awful and no one deserves it.

So. This is a shitty hack, but you have Kaiser insurance, so shitty hacks for mental health care might be required to get shit done.

If one was suicidal, and did not think they could keep ones self safe, and presented themselves at an ER, they would be offered a voluntary hospitalization at an inpatient mental health facility. One can decide to check out after 24 hours of staying in a facility like this. However, just being admitted to such a facility immediately bumps to to the front of a waitlist to see a psychiatrist in the kaiser system. One can often see a psychiatrist within 48 hours of a hospitalization.

Kaiser runs these inpatient facilities, they are intensely shitty places and you should be fully prepared for an awful experience. They are not good places. I honestly do not recommend doing this unless it is an absolute last resort. It is possible visiting one of these facilities will be traumatizing.
posted by furnace.heart at 10:06 AM on May 13

Source (Me): I work in scheduling at a community health center in Northern Cali.

Just wanted to add in that in California LCSW's, MFT's and Psychologists don't have the ability to prescribe medication or approve medical leave which is why the one you saw at Kaiser wasn't able to. Any family practice/PCP physician will be able to help you with the FMLA paperwork, so it's likely the rando you see on Monday can at least get the ball rolling. Not sure how helpful I can be, but my memail is open as well.
posted by Jarcat at 11:27 AM on May 13 [1 favorite]

When you see the random doctor, have a clear list of the actual symptoms - the facts about how you are functioning on a day to day basis and how that is impacting you. It's this kind of stuff:
My memory is shot, I can't eat or sleep, and I'm hyper-vigilant and reactive to everything, my resting heart rate is through the roof but be prepared to be as specific as possible. (Does it happen every day? Multiple times a day? What does "can't sleep mean?" How long to fall asleep, how often awake during the night, impact of sleeplessness on the rest of your day. The doctor might not need all of this detail but they are going to need to check boxes to give you a diagnosis so giving them the things to match to their boxes will help.
posted by metahawk at 11:57 AM on May 13 [3 favorites]

I’d go to an ER. Do you have to go through Kaiser? Or can you find a psychiatrist on whom you can pay out of pocket, if it’s feasible. You may get in much faster than with someone paneled with insurance.
posted by executive_dysfuncti0n at 1:40 PM on May 13

I'd try to get out of pocket therapy and not even try with Kaiser. It was a complete waste of time to try to get any mental health with them this year for me. If you can get someone else who isn't Kaiser to sign off, maybe.

Unfortunately, finding therapists at all is hard going these days.
posted by jenfullmoon at 1:48 PM on May 13

For FMLA, you just need a medical professional with the authority to do so to sign off on it. A PCP, a random MD you can get in to see, any of them will do. They can prescribe you drugs? Then they can sign the FMLA paperwork.
posted by purple_bird at 2:45 PM on May 13 [1 favorite]

My therapist is an LCSW and she said she could sign off on FMLA paperwork if I ever get that bad--doesn't have to be "someone who can prescribe drugs," apparently.
posted by jenfullmoon at 3:07 PM on May 13

I’m you but slightly in the future. I paid a psychiatrist out of pocket for the dual benefit of a) receiving the urgent medical care I needed and b) getting my paperwork signed off on. I am not a person of means by any stretch but it was well worth the $300, and then I transitioned to providers within my network.

Be so so kind and gentle to yourself; sending virtual hugs your way.
posted by nancynickerson at 6:22 PM on May 13 [3 favorites]

I'm a (professional) leave of absence specialist, but I'm not your leave of absence specialist. I've also been in your shoes- I've taken two mental health FMLA leaves at two different companies. For the first, I checked myself into a mental health facility. I was there for 4 days as an inpatient before moving to an intensive outpatient program. I went back to work after 12 weeks. For the second, I told my employer I was going on a leave of absence, then had to wait a week to see my usual psychiatrist who wouldn't sign the paperwork until I was checked into another intensive outpatient program and was safe. Most employers require paperwork with 15 days of your first missed day of work, but if you are making a good faith effort extensions may be available. The priority is you. Please, please, please make sure you're safe.

If you're in California (I hear Kaiser, I think CA), you may also have additional protections available to you. I will say that Kaiser HATES signing FMLA paperwork. They're known for it in the industry. They have their own set of paperwork that most employers accept instead. Your employer should accept this paperwork as you are making a good faith effort. And just in case your employer tries this- California paperwork does NOT require a diagnosis.

The important thing right now is to get yourself safe. If that means taking sick time or calling out sick until you can see a PCP or a psychiatrist, do that. If you're comfortable telling your manager you're unwell, do that.

The doctor you're seeing on Monday should be okay with at least signing papers until you can get into see a psychiatrist. Take in a print out of this post if you have to, describe how it's impacting your work function, express that you need this time to get yourself into a high-demand doctor, you're taking care of yourself, and that you're not a risk to yourself right now. (Unless you are, in which case- please seek help in the ER. Inpatient treatment is terrible, but it beats the alternative.)

I don't know the etiquette here, but please feel free to me-mail me if you're comfortable. I've been in your shoes, I now write policy for companies, and I know that LOA can be a labyrinth of shit.
posted by Torosaurus at 8:19 AM on May 14

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