1: Discussing Parental Leave With Patients

In the first installment of "Psyched Perspectives," a series in which he will converse with his colleagues about the practice of psychiatry, host Frank A. Clark, MD, sits down with Jessica Obeysekare, MD, to discuss parental leave. When interviewing patients who are soon to be parents, Clark and Obeysekare find that many express anxiety, specifically anxiety around work. Can they take time off? How much time off do they receive? Should they quit their job and try to find another? How would such a decision impact their benefits?

Obeysekare is a psychiatrist at Prisma Health. She trained at Brown University for medical school and residency, and is board certified in psychiatry and addiction medicine. She is a clinical assistant professor at the University of South Carolina School of Medicine Greenville and Clemson University School of Health Research. She is also the associate program director for the Greer Psychiatry Residency program.

In 1993, the Family and Medical Leave Act (FMLA) was passed. This is a federal law that allows eligible employees to take unpaid, job-protected leave for certain family and medical reasons, including birth and care of a newborn, adoption or foster care, caring for a family member with a serious health condition, or an employee's own serious health condition. However, in order to receive FMLA time, employee's must meet certain conditions. In 2018, only 56% of US employees were eligible. It then becomes the employee's responsibility to find ways to spend time with a new baby, including state policies, choosing to work at companies that offer paid leave, utilizing sick or vacation days, and more.

"Families that make less money are less likely to qualify for FMLA," said Obeysekare. "The other thing is, with unpaid leave, when you see unpaid leave expansions, the people who benefit from that psychologically are people who can afford to take more unpaid leave. So it's really a luxury to able to take more time not getting paid, away from work."

According to Obeysekare, research shows that work leave lasting less than 12 weeks is associated with increased rates of postpartum depression. If, at the 4 month mark, the parent really wants to go back to work, research shows it is better for mental health to return to their job. 

The duo suggest that mental health and business must work together at a state and federal level to form a partnership, one that cares both about family happiness and economic outcomes. Cost of pregnancy, employee turnover, and other factors will be important considerations. 

Talking about parental leave early on with patients could help improve outcomes. Creating a plan, especially one that focuses on sleep for parents, is important. Talking openly and freely about this topic is beneficial for patients.