PENNSYLVANIA — Mental health and substance use challenges quietly drained nearly $44.6 billion from Pennsylvania’s workforce over the past five years, according to a new nationwide survey that points to widespread confusion about federal protections and a culture of fear that keeps millions of employees suffering in silence.
The study, conducted by RenaissanceRecovery.com and based on responses from 3,002 workers nationwide, found that Pennsylvania employees lost an average of $10,854 each over five years due to mental health or substance use issues that disrupted their ability to work. Statewide, that translated into an estimated $44,593,720,114 in lost income.
Nationally, the economic toll was even more staggering. Forty-one percent of respondents said a mental health or substance use issue affected their ability to work, and those workers estimated losing about 16% of their income. That amounted to an average loss of $10,968 per person and more than $1.15 trillion nationwide over five years, the survey found.
Researchers said the losses are being amplified by a striking lack of awareness about existing federal protections. Fewer than half of workers surveyed, 46%, knew that federal law allows eligible employees to take job-protected medical leave for mental health or substance use treatment.
Under the Family and Medical Leave Act, eligible workers are entitled to up to 12 weeks of unpaid, job-protected leave for serious health conditions, including mental health and substance use treatment. While the leave itself is unpaid, some workers may qualify for income replacement through employer short-term disability plans or state-paid family and medical leave programs. The survey found that understanding of how these benefits work remains limited.
Only 38% of respondents said they were very familiar with FMLA. Another 27% had heard of it but did not know the details, and 16% said they had never heard of it at all.
That confusion appears to directly influence whether workers seek help. When asked which situations qualify for protected medical leave, respondents overwhelmingly pointed to physical illness or injury and surgery or recovery. Only 15% believed mental health treatment qualified, and just 3% recognized substance use treatment as a valid reason. Nearly 8% said they did not think any of the listed reasons qualified.
Despite the prevalence of mental health challenges, many workers said they continued working rather than take formal leave. Among those respondents, the most common reasons were fear of losing their job, not knowing leave was an option, and being unable to afford unpaid time off. Losing income was cited as the top concern around taking leave, followed by fear of being fired or laid off.
The pressure to keep working often led employees to hide the real reason they needed time off. More than 56% of respondents said they had lied or downplayed their situation, while many said they would feel safer citing a physical illness or family emergency instead of mental health needs.
The consequences of pushing through were significant. Nearly 61% of respondents said continuing to work made their condition worse, and 42% reported long-term career impacts such as slowed advancement, turning down opportunities, or leaving a job entirely. On average, workers estimated they lost $10,457 in income due to delayed treatment or ongoing struggles.
Losses varied widely by state. Workers in Massachusetts experienced the highest estimated income disruption, at $14,050 over five years, while those in Mississippi reported smaller losses averaging $7,698.
Alina Nejadian, clinical director at RenaissanceRecovery.com, said the findings show that uncertainty and misinformation are compounding an already serious problem.
“What this data shows is that many workers aren’t just struggling with their mental health, they’re struggling with uncertainty, fear, and misinformation,” Nejadian said. “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.”
The survey’s authors said improving outcomes may depend as much on education and workplace culture as on policy itself, warning that without clearer communication and stronger trust, the hidden economic and human costs will continue to climb.
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