PROJECT SUMMARY/ABSTRACT Mental health disorders are common, chronic, and costly health conditions for individuals, families, and communities. Treatment options are available, but treatment is underused with less than 50% of adults and 20% of children with mental health disorder receiving treatment each year. There are myriad reasons for not receiving treatment. A potential barrier that has received limited research attention is the time required to receive mental healthcare, which can be time consuming. Time constraints are likely salient for the employed, who much schedule mental healthcare appointments – either for themselves or their dependents – around work hours. The U.S. is one of three industrialized countries that does not have a federal policy that allow employees to take paid time off to attend to healthcare needs of themselves and their families. As of July 2021, 14 states and 21 cities have adopted paid sick leave (PSL) mandates that confer on average 7 days of PSL per year, mandated PSL can be used for mental healthcare. There is strong public support among Americans for PSL, 84% support PSL, and states and localities continue to adopt PSL mandates. The long-term objective of our proposed research is to assist in optimal design in public health policies that allow employees and their families to receive valuable mental healthcare and improve mental health. Specifically, the immediate objective of our application is to use rigorous quasi-experimental methods (e.g., difference-in-differences methods) and high quality, reproducible data (both insurance claims and survey data) to estimate the causal effect of PSL mandates on i) access to PSL among employees with mental health disorders, ii) use of mental healthcare among employees and their dependents (e.g., children and partners), and (iii) indicators for potential quality of mental healthcare received. We will study the extent to which community-level factors (mental healthcare workforce infrastructure, race/ethnicity, and socioeconomic status) mediate the causal effect of PSL mandates on our outcomes. Our data sources are IBM Marketscan commercial claims and the National Health Interview Survey. We will perform analyses separate for adults and children, using variation from all state and city PSL mandates through 2022. A rationale for our proposed research is that mental health disorders are leading causes of morbidity and mortality in the U.S. and use of mental healthcare are below recommended levels and PSL mandates are currently being adopted across the country, raising the importance of understanding how PSL can be used to remove barriers to treatment. Our project is significant by providing new information on the benefits of mandating PSL and potentially removing an under-studied, but empirically important, barrier to treatment: time.

PROJECT NARRATIVE The U.S. is one of just three industrialized countries that does not have a federal paid sick leave (PSL) mandate and many employees do not have access to PSL, states and localities have adopted PSL mandates given the federal void. Work commitments and the prospect of lost wages are factors contributing to delays in seeking medical care, including mental healthcare treatment, both for employees and for their dependents (e.g., children and partners). This project will provide the first causal estimates of the effect of state and local PSL mandates on access to PSL among those with mental health disorder, use of mental healthcare, and indicators of potential quality of mental healthcare received, and will examine how community-level factors (e.g., mental healthcare workforce and socioeconomic status) mediate PSL mandate impacts.