I get paid time off every pay period and as that builds up I'm able to take time off. When I first started and had no time off... I just didn't take time off till I accumulated enough time. I was fortunate that I was seeing my psychiatrist every 3 months and I had a therapist weekends or nights.

Honestly, it all depends on the employer. Some don't care if you utilize your paid time off and some do. My old employer required us to always have 40 hours on the books at all times. It was tough and I hated that job.

My current employer is a lot more lenient and encourages mental health days.

Not sure this helped.