The statistics concerning mental illness and employment can appear bleak, at times. A 2019 research brief found on the ADA National Network (adata.org) website called: Mental Health, Employment, and the ADA, discusses the prevalence of those living with a mental illness who work full-time as follows:
“Over 46 million adults in the United States have some kind of mental health condition, and 11.2 million adults have a significant psychiatric disability1. Mental health conditions are the most common disability in the U.S., yet there are significant disparities in employment. Only 38.1% of adults with significant psychiatric disabilities are employed full-time compared to 61.7% of adults without disabilities2. These disparities exist despite policy protections for people with disabilities, as seen in the Americans with Disabilities Act (ADA)”. (Parker Harris, S., Gould, R., and Mullin, C., 2019)
This information as well as other helpful guidance regarding the Americans with Disabilities Act (ADA) can be found on the website: ADA National Network (adata.org).
Employers are required under the ADA to provide reasonable accommodations to an individual with a qualified disability absent “undue hardship”. Undue hardship, as defined by the U.S. Equal Employment Opportunity Commission (EEOC.gov), “means that the accommodation would be too difficult or too expensive to provide, in light of the employer’s size, financial resources, and the needs of the business”. The laws, however, surrounding these issues can be sometimes vague, leaving room for interpretation and ultimately causing some individuals seeking accommodations to feel vulnerable after disclosure. Imagine getting up the courage to disclose a highly stigmatized illness to an employer, only to feel less supported and valued by them! Although, each workplace and individual will approach the accommodations process uniquely, it can be helpful to share experiences in hopes that people can support one another in navigating the world of employment while living with a psychiatric disability.
My personal experiences of requesting accommodations for both Bipolar 1 and ADHD in the workplace resulted in increased stress and anxiety, causing an exacerbation of symptoms, and in some cases, a constructive discharge or wrongful termination. Many workplaces are not equipped currently, due to both attitudinal and structural barriers, to appropriately accommodate those struggling with a mental illness in the workplace. There is a lot of education and awareness that needs to occur for employers to be truly inclusive and embrace diversity in the workforce, enabling opportunities for those with psychiatric disabilities who wish to work and remain competitive.
As an individual who has worked for many years while struggling with a psychiatric disorder, I am intimately aware of the pervasive stigma attached to my disability. I have faced, what I believe to be, discrimination, while working. The last several work attempts I decided to disclose my disability in hopes to receive accommodations during times when I was symptomatic. I had hoped that by doing so, it would allow for increased awareness and support. Workplace stress can trigger symptoms and the disclosure of my disability and request for accommodations was a sincere attempt at helping my employer understand how my illness affects me at work and what approaches could be used to benefit both my employer and myself. I wanted this to be a mutually beneficial endeavor, a “win-win” for everyone involved. I had the support of my medical provider and he agreed that the request was reasonable and would not be considered as causing “undue hardship”. Even so, my request for accommodations left me feeling more vulnerable and less supported.
Although there are many workplaces providing accommodations in a supportive manner, I wanted to give a voice to those experiencing vulnerability, or even discrimination, after disclosure. I have seen many people on-line with stories very similar to mine. Unless we give a voice to those being disenfranchised, we miss a true opportunity to help others understand why it is so very important to handle accommodations requests with a genuine desire to retain employees who live with a psychiatric disorder. The stigma surrounding mental illness doesn’t just disappear during a disclosure at work and many times the myths perpetuated about mental illness are reiterated and even perpetuated by those in the workplace. The ADA is written with inclusivity in mind, and yet, employers are often comprised of people subject to biases and prejudices with a mindset that is difficult to change. It’s up to us as a community to speak out and bring awareness to the harm and damage that stigma in the workplace can cause.
Here are the 4 things I wish employers understood about accommodating those living with a psychiatric disorder in the workplace:
- When I request accommodations, I genuinely want to be a successful employee of your organization and want the same opportunities to compete. The US Department of Labor website (dol.gov) defines a job accommodation as “an adjustment to a job or work environment that makes it possible for an individual with a disability to perform their job duties. Accommodations may include specialized equipment, modifications to the work environment or adjustments to work schedules or responsibilities”. Although, I might do the job a bit differently from others, my goal will always be to do so in a way that benefits and adds to the success of the organization. We have the same goals in mind. I might need, at times, to approach the way the work is completed differently in order to enable success. I’ve always been told I am creative and an “out of the box thinker”. I would love to be seen as an asset and continue to contribute competitively. Often, when I have disclosed a disability, the attitude that is displayed from the employer is that I am asking for a “favor” or that perhaps I am even requesting accommodations to be excused from an unpleasant duty, etc. This could not be further from the truth. No one would risk disclosing a disability and being vulnerable, just to get out of an assigned duty. It is a stressful process that requires medical documentation and support. I want to continue being seen for my strengths and do not want the disclosure of my disability to change your view of my capabilities and strengths.
- Please remember that the accommodation process is a flexible one that is guided by interactive dialogue and even trial and error. The Job Accommodations Network described this process on their website (askjan.org) as follows: “When an accommodation is not obvious, an appropriate accommodation is best determined through a flexible, interactive process. As part of this process, the EEOC recommends that employers: (1) Analyze the particular job involved and determine its purpose and essential functions; (2) Consult with the individual with a disability to ascertain the precise job-related limitations imposed by the individual’s disability and how those limitations could be overcome with a reasonable accommodation; (3) In consultation with the individual to be accommodated, identify potential accommodations and assess the effectiveness each would have in enabling the individual to perform the essential functions of the position; and (4) Consider the preference of the individual to be accommodated and select and implement the accommodation that is most appropriate for both the employee and employer”. There have been times after I disclosed my disability, that the process became very rigid and even punitive. For instance, I wanted to temporarily change my schedule for a few weeks to 32 hours a week instead of 40 hours weekly. They provided the accommodation, but permanently cut the hours, meaning I was now taking a significant pay cut and they would not allow me to return to full-time once my symptoms abated. In another workplace, I requested to revisit accommodations and was denied the opportunity to do so. When this occurred, it was accompanied by other actions and comments that leads to a constructive discharge as the employer wasn’t demonstrating a willingness to accommodate. I won my unemployment claim on this issue alone as the judge ruled it was a constructive discharge due to being denied accommodations.
- Denying accommodations in the workplace, wrongfully terminating an employee with a disability, or engaging in any other discriminatory practices is truly harmful on a variety of levels. Loss of employment for someone living with a psychiatric disability can be particularly devastating. Not only does this come with loss of income and potentially housing, it also can disrupt one’s medical care. Medical insurance in the US is usually tied to one’s job and losing employment can result in an individual not being able to afford to continue treatment and thus have a lapse in treatment. Often times, one has to move for employment or even to secure housing due to loss of income and an inability to pay rent, and this means starting over with new providers unfamiliar with the treatment regimen. It can potentially cause relapse. Also, moving and starting a new job are stressful for any individual and can be particularly distressing for those who live with a psychiatric disorder. A few of these “bad experiences” can be really devastating. In my own experience, two back to back experiences where I was wrongfully terminated and denied accommodations resulted in a relapse where the continuity of care was disrupted, housing and savings were lost, and a relapse occurred. I ended up applying for SSDI and was later approved. I applied for vocational rehabilitation while waiting for approval and was waitlisted for nearly three years. Employers should truly consider the full scope of damages that can occur when the ADA is violated in any way. Those who feel they have experienced discrimination can file a claim with the EEOC (EEOC.gov). In my experiences, however, they have been extremely slow to act and it took a year or more for the process of mediation to begin.
- Employees who face discrimination of are left powerless and this can lead to exacerbation of their symptoms, disability, and even death. The cost of disability discrimination in the workplace can have real consequences, not only for the individual, but the greater community as well. While no one single employer could be said to definitely cause disability or death, multiple incidents over time, can certainly lead to those realities for some. Mental illness is deadly, for some, and experiencing periods where treatment is inaccessible can increase the risk for tragic outcomes for those struggling. For certain people, they get caught in the cycle of having to continually “start over” due to losing employment during their probationary period when workplaces often discourage taking time off and may even deny access to vacation/paid time off (PTO) time. PTO is accrued over time and in many instances this leaves those with disabilities, who need time off for medical appointments, more vulnerable. They may put off needed appointments for fear of consequences with their employer and as a result their health may suffer. When this occurs, accommodations might be requested, but by this time the employee is already feeling fearful and uneasy about doing so. The workplace, not having a longer history with the employee, might be wary about the request. The employee might lose the position and thus has to start over again, only to be right back in the same predicament. The stress of losing a job, starting over, and potentially moving, all while not getting one’s healthcare needs met can be extremely overwhelming and triggering to someone struggling with anxiety and/or depression. Often, people in these positions are left having to justify and explain gaps in employment, and with the concern of stigma, most are hesitant to divulge their diagnosis in an interview setting for fear of not landing the job. Those in this position are stripped of any real power. If they left a place where they were performing well, but were denied accommodations or experienced discrimination, the employer holds the power of providing a reference or not. Due to stigma, those experiencing a psychiatric disorder may not be viewed as credible by some. The burden of living with such a highly stigmatized illness becomes oppressive in and of itself. This ultimately leads some to despair and hopelessness which can cause continual relapse.
In my case, after experiencing discrimination, I not only relapsed, but received the additional diagnosis of fibromyalgia from the continual stress and tension working caused. I do believe I could have been successful and wanted to work, but I needed the workplace to follow the spirit of the ADA and be sensitive towards the issues I was facing. Instead, I faced discrimination on a few occasions. The final straw that broke the camel’s back for me was being terminated by a state agency after an approved medical leave! They actually fired me my first day back from the medical leave at a meeting set up to address my accommodations request. This caused a relapse and I ended up on disability, losing everything, and was severely depressed for a few years.
My goal in writing this post is to inform others and bring awareness to the issues surrounding employment and mental illness. I hope to work in advocacy one day, helping others to navigate the system and perhaps even help employers see the value in employing those who live with a psychiatric disability. Diversity in our workforce is always a benefit! Learning to approach the workplace in a different way in order to make it more inclusive, is well worth the endeavor, both for the individual and the community.
*Parker Harris, S., Gould, R., and Mullin, C. (2019). ADA research brief: Mental health, employment and the ADA (pp. 1-6). Chicago, IL: ADA National Network Knowledge Translation Center.
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