In my previous job as a vocational rehabilitation counselor, I helped individuals with psychiatric disabilities transition back into the workforce and witnessed firsthand the difficulties faced by those re-entering the work place after a significant mental health setback. In my current position as a clinical interviewer, which involves conducting diagnostic assessments with hospitalized patients – many of whom are professionals – my previous experience has been reinforced.
While many disabilities are observable, and thus generally accepted by employers as requiring accommodations on the job (e.g. in the form of assistive technology, duty modifications and medical devices), mental illness is not obvious. In fact, it’s sometimes referred to as “the invisible disability.”
The impact of mental illness is often minimized in work settings despite statistics that demonstrate one of the greatest costs to employers is unaddressed psychiatric illness. “In the United States, the annual economic, indirect cost of mental illness is estimated to be $79 billion. Most of that amount — approximately $63 billion — reflects the loss of productivity as a result of illnesses.”¹ According to the Harvard Mental Health Letter, “The indirect costs of mental health disorders — particularly lost productivity — exceed companies’ spending on direct costs, such as health insurance contributions and pharmacy expenses.”²
Mental illness might not seem to qualify as a “true disability” because of the colloquial use of the terms “depression” and “anxiety” and the sometimes flippant conversations about “taking a mental health day,” which detract from the significance they hold for those with diagnosable mental disorders. For those suffering from anxiety or mood disorders, to be depressed or anxious might mean struggling to get out of bed every morning due to paralyzing anxiety or debilitating depression; striving to focus at work while trying to hold the panic at bay; or exhausting efforts to maintain the façade that everything is OK in order to evade questions or comments from coworkers or supervisors.
Additionally, coworkers and employers who are unfamiliar with psychiatric disabilities can have difficulty tolerating the limitations such disorders can present on the job, in part because the person looks otherwise “normal.” The assumption that a healthy physical appearance equates to a healthy mind is problematic for individuals with significant psychiatric illnesses. The result can be limited patience on the part of the employer when problematic symptoms begin to cause concerns or interfere with work. When individuals start coming in late or struggle with productivity, their managers may believe the person is lazy or irresponsible. As a vocational rehabilitation counselor, I also educated employers on the potential limitations of mental illness in the workplace, suggested reasonable accommodations and provided data suggesting that people with disabilities are more likely to stay with a job longer than individuals without disabilities.³
Disclosure: how and when?
Another component of my previous position was counseling individuals with disabilities on how and when to disclose their disability. Everyone has the right to keep their psychiatric conditions confidential; however, it is important to consider how they may interfere with work performance. In such cases it may be in the individual’s best interest to disclose to their employer so that the appropriate accommodations may be provided. These can go a long way toward minimizing disruptions due to poor job performance, excessive absences and possible termination.
There are potential downsides to disclosing disabilities to one’s employer: the fear of termination, lessened workload leading to delay in advancement or the possibility of a breach in confidentiality. The upside to open and honest communication with an employer is the possibility for accommodations which can help employees feel more confidant and secure, while potentially minimizing absences and possible job turnover due to symptom exacerbation. If employers do not have prior knowledge of a person’s need for accommodations, they may have grounds for termination if that person cannot adequately perform the job duties of their position.
Despite many employers’ best efforts to act ethically and professionally when managing employees with mental health issues, uninformed employers may reveal a stigmatized view on mental illness. The concept of “pulling oneself up by the bootstraps” is frequently associated with mental illness in the workplace: It is seen as something within the person’s control, a matter of will power. Yet extensive research documents the biological basis of mental illness such that, like hypertension or diabetes, the illness is not entirely within the individual’s control.
However, it is also important to acknowledge the employee’s role in understanding, and at times accepting, the limitations their mental illness may present in a work setting. It is the employee’s responsibility to acknowledge if and when positions or responsibilities are beyond their ability. Good self-care involves knowing limits as well as strengths.
Mental illness can create significant problems in a work setting beyond the typical “mental health day” that some people might need in order to recalibrate. If mental illness is not properly addressed and accommodated by both the employer and employee ahead of time, then potentially avoidable stressors might not only impair job performance but also exacerbate the psychiatric illness.
- U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, Md., U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services,1999, pp. 408409, 411.
- Harvard Mental Health Letter. “Mental health problems in the workplace.” February 2010.
- Benefits of Employing People with Disabilities. October 15, 2009.