Mental Illness in the Workplace: Don't Ask? Don't Tell?

Today, many persons with even the most serious mental illnesses are capable of working in mainstream, competitive jobs. Thanks to a new generation of drugs, the acute symptoms of schizophrenia, bipolar disorder, and major depression can be controlled for many patients, so that many persons with these disorders are able to hold full-time jobs. The new drugs cannot, however, cure mental illness, and many individuals continue to experience residual symptoms of their disorders. At work, they face a dilemma: Should they tell their employer about their diagnosis? Will disclosure result in support and job accommodations, or stigma and discrimination? A new study, sponsored by the National Institute of Mental Health, is investigating this topic. The study aims to discover how employers and workers can talk about mental illness in ways that result in more successful work outcomes.

Disclosure is the path to employer-provided job accommodations.

The Americans with Disabilities Act (1990, 2008) mandates that employers provide reasonable accommodations to workers with disabilities who are otherwise capable of performing the essential functions of their jobs. The Job Accommodation Network (JAN) cites the following example of a reasonable accommodation for a worker with serious mental illness:

A clerical employee with schizophrenia who sat in the middle of a large, open office was in constant turmoil because she believed her co-workers were plotting behind her back. Although her employer could find no evidence that this was true, it was very real to the employee. The employer moved her to a location on the perimeter of the office space, where she had her back to a wall and could face other employees. The accommodation made a tremendous difference in the employee’s ability to get her work done.

Other reasonable accommodations for workers with mental disorders might include noise- canceling headsets to block out distractions; a modified break schedule to relieve stress; a semi-private work space for a worker who has difficulty interacting with others socially; or other accommodations identified on the JAN website.

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Under the ADA, however, workers who request reasonable accommodations must disclose the nature of their disability to their employer. Thus, the law essentially makes disclosure mandatory for workers who need accommodations to be successful in their jobs.

But disclosure is risky.

By far the most common reason for not disclosing a mental illness at work is fear of stigma and discrimination. The stigma against mental illness is intense, comparable to the stigma associated with HIV-AIDS or alcohol and drug abuse. An individual who reveals mental illness at work risks being perceived as unstable, incompetent, unreliable, or even dangerous.

Many workers with mental illness fear that disclosing their diagnosis to their employer will adversely affect their employment status. Negative outcomes may include being demoted to a lower-paying job, being passed over for promotion, or even being fired. Disclosure can also trigger changes in performance expectations, with consequences of being assigned to less- important tasks, being supervised more closely, even being assigned to a heavier workload. In 2018, charges involving mental illness-related discrimination represented nearly one-fourth of the merit resolutions (findings in favor of the employee) decided by the Equal Employment Opportunity Commission under the ADA. [1]

Likewise, a worker who tells co-workers about his or her mental illness cannot be certain of their response. Understanding co-workers may respond with sympathy and helping behaviors, but co-workers who believe the negative stereotypes of mental illness may respond with avoidance, condescension, fear, or hostility. Apprehensions about being ostracized, and being perceived as ‘different,’ create powerful motives not to disclose. As one worker says:

Usually when you start talking about yourself on the job, that tends to make them treat you different . . . I don’t want to tell anybody, because people who aren’t ill, they do have a tendency sometimes to treat you different. They’ll start teasing you or they’ll shy away from you. It’s a strange thing about us, the mentally ill, we’ve got to disguise ourselves a lot, because people who aren’t ill, when they know things about you, they tend to treat you different. [2]

Paradoxically, many workers who say that they would not disclose their diagnosis of serious mental illness at work still believe that work would be easier for them if their employer knew about their illness. [3] There is, however, almost no research on the process of disclosing mental illness in a competitive job. A better understanding of how disclosure occurs, and how employers respond, could inform policies that would empower more workers to talk about their mental illness with their employer, with confidence in a positive outcome.

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Study of workplace disclosure of mental illness

A cross-disciplinary research team from Arizona State University and the University of Pennsylvania is conducting a study that will provide the first-ever systematic evidence on the process of disclosing serious mental illness in the workplace. The study aims to identify how the process of disclosure can be managed so that it is most likely to result in reasonable job accommodations and long-term stable employment. Ultimately, the results from the project will help to inform interventions to improve competitive employment outcomes for this marginalized population.

Over the course of three-and-a-half years, we will survey 1,000 persons with schizophrenia, bipolar disorder, or major depression who have worked in a competitive job after onset of mental illness. The survey collects data on whether they disclosed their illness to their employer; whether they requested and received employer-provided job accommodations; and their current employment status and wages. In addition, we ask about a number of individual and workplace characteristics that can affect the process of disclosure and work outcomes—for example, the respondent’s education level, current symptoms of mental illness, and engagement with mental health providers. Examples of workplace characteristics include firm size, job expectations, and characteristics of the worker’s supervisor. When complete, the survey will provide the largest-ever data set on the experiences of persons with serious mental illness in mainstream, competitive jobs.

In addition, from among the survey respondents, we identified a targeted sample of 50 workers for more in-depth, follow-up interviews on the disclosure process. In these open-ended interviews, workers were asked to tell their stories about disclosing (or not disclosing) mental illness at work. These interviews are complete. Preliminary analyses of the data reveal that disclosure is not always a voluntary choice: Some workers are “outed” in other ways, and some choose to disclose only when they believe their job will be in jeopardy if they do not receive accommodations.

The overall goal of this project is to inform best practices for disclosure decisions that will lead to improved employment outcomes for persons with serious mental illness who are capable of competitive employment. The project has tremendous potential to empower these individuals to manage the disclosure process in ways that increase the likelihood of effective job accommodations, successful employment, and financial independence.

To learn more, go to smistudy.com.