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Disclosure of Mental Health Disabilities in the Workplace

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Work Accommodation and Retention in Mental Health

Abstract

There are a number of barriers that contribute to the low employment rates of people with mental health disabilities; these barriers exist at the individual level, the programs and services level, and the systems, policy, and societal level (Anthony et al. 2002). One issue that intersects with all three is disclosure of psychiatric disability in the workplace. Individuals with mental health disabilities must weigh the personal benefits and risks of disclosing their psychiatric disability and make a number of decisions about disclosure given their particular employment circumstances. In addition, employment programs and services, and especially supported employment practitioners, must determine how to represent their services to employers, decide how to inform employers that they work with people with mental health disabilities, and plan with the individual to handle disclosure. Employers must be aware of state and federal policies regarding disability-related employment issues in the face of societal stereotypes, personal experiences with, and misunderstandings about people with mental health disabilities. And while legislation such as the Americans with Disabilities Act (ADA 1990) is in place to protect rightful access to employment, people with mental health difficulties may have little knowledge or understanding of these policies or how disclosure of disability and reasonable accommodations may allow them to enjoy full access to employment opportunities.

Note about language: Throughout this paper, the term “people with mental health disabilities” is used to refer also to individuals with psychiatric disabilities or conditions. This term is meant to describe individuals who have significant mental health impairments that interfere with functioning and employment in particular and where reasonable accommodation or protection under the ADA may be indicated.

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Correspondence to Kim L. MacDonald-Wilson .

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Appendices

Appendix A

Tasks for Preparing to Disclose

  1. 1.

    Clarify knowledge about the ADA, accommodations, and disclosure of disability guidelines

  2. 2.

    Explore experiences and feelings about:

    1. (a)

      Past experiences with disclosure and/or stigma

    2. (b)

      Phase in recovery, severity and/or visibility of disability, identifying as a person with a mental health diagnosis, label, or disability, implications of recovery for disclosure

    3. (c)

      Sharing diagnosis or disability information with others, especially employers.

  3. 3.

    Review expectations of and needs for disclosure

    1. (a)

      Confidence and skill in disclosing and/or requesting accommodations

    2. (b)

      Confidence and skill in regulating impact of mental health condition on work

    3. (c)

      Practical and personal reasons to disclose or not disclose

    4. (d)

      Anticipated reactions of coworkers, supervisors, or others

    5. (e)

      Expected outcomes of disclosure and requests for accommodations.

  4. 4.

    Determine support needs for:

    1. (a)

      Involvement of VR or employment professional in hiring or once on the job

    2. (b)

      Support or connection wanted or needed from coworkers, supervisors

    3. (c)

      Explaining gaps in work history, visible signs of disability, recent hospitalization, or other unforeseen circumstances or behavior

    4. (d)

      Potential interference of disability on functioning or other issues in meeting job expectations due to disability or needed treatments.

  5. 5.

    Identify any potential accommodations needed and their timing

    1. (a)

      Assess job search skills and needed accommodations in hiring process:

      • Initiating contact or arranging an interview with an employer

      • Interviewing

      • Describing the disability, functional limitations, or needed accommodations

      • Providing documentation, if requested

      • Negotiating accommodations

    2. (b)

      Examine any functional limitations or issues related to meeting job expectations experienced due to the disability

      • Identify accommodations or supports

      • Determine whether accommodations/supports occur naturally in the job environment

    3. (c)

      Evaluate urgency – when accommodation is needed in employment process (in hiring, as soon as job starts, once on the job after awhile)

    4. (d)

      Explore whether accommodation will help others, if it is essential to work tasks or meeting customer needs, and other benefits to the employer and employee

  6. 6.

    Analyze the employer and job environment to determine potential reactions/support

    1. (a)

      Workplace culture

      • Sensitivity to mental health issues, such as information on disabilities in newsletters, posted notices, employee education or training programs

      • Policies such as flex time, mentoring programs, telecommuting, flexible benefit plans, employee awards, or other incentives for contributing to diversity efforts.

      • Type of job that precludes disclosure of mental health disabilities, such as in child care, government high security positions, police work, etc.

    2. (b)

      Employer/supervisor knowledge of ADA and experience with people with mental health disabilities

    3. (c)

      Employee’s perceptions about:

      • supportiveness of the coworkers, supervisors, customers

      • characteristics of relationships with coworkers, supervisors, and other personnel

      • likelihood of a positive reaction to disclosure or accommodation request

    4. (d)

      Employee’s level of job, status in the organization, industry type, recent job performance, perception of job security, nature of job

  7. 7.

    Weigh the benefits and risks of disclosure. Consider:

    1. (a)

      Past experiences, and confidence and skill in disclosing

    2. (b)

      Position or status in the organization, length of time in job, job security

    3. (c)

      The need for involvement of a professional with the employer in the job search process or once on the job (i.e., visibility of condition, symptoms, or medication side effects, limited job search skills)

    4. (d)

      Urgency and need for accommodation

    5. (e)

      Personal reasons, such as:

      • identifying as a person with a disability

      • concerns about legal rights

      • need to screen out unsupportive or inflexible employers or job situations

      • relief of stress in not hiding information about self

      • interest in being a role model for other people with disabilities

      • skills in handling the experience of stigma or discrimination with coworkers, supervisors

    6. (f)

      Relationships with supervisor, coworkers, and/or customers in the workplace

    7. (g)

      Likelihood of employer and/or coworker support

  8. 8.

    If the decision is made NOT to disclose, prepare the following:

    1. (a)

      Decide what to say about potential issues that might lead an employer to suspect a disability, such as gaps in employment, frequent job changes, poor references, or other potentially visible signs of disability.

    2. (b)

      Plan the behind-the-scenes support that will be needed in hiring or on the job.

    3. (c)

      Research employers and jobs that provide the supports naturally, or identify self-accommodations that could be made without disclosure.

    4. (d)

      Develop alternative skills and supports to address potential functional limitations.

  9. 9.

    If the decision is made to disclose, plan how the disclosure will be handled – WHO, WHAT, WHEN, and TO WHOM

    • Adapted from: MacDonald-Wilson (2005,2008) and MacDonald-Wilson and Rea (2008)

Appendix B

Tasks for Disclosing

  1. 1.

    Clarify the purpose (Why) of the disclosure – practical and/or personal reasons (seeTasks for Preparing to Disclose)

  2. 2.

    ChooseWhowill be handling the disclosure

    1. (a)

      Professional, if involved with employer (implicit or explicit disclosure)

    2. (b)

      Applicant/employee

    3. (c)

      Other

  3. 3.

    DecideTo Whomyou will disclose

    1. (a)

      Interviewer, trusted coworker, supervisor, human resources

    2. (b)

      Choose whether educating coworkers would be useful, and if so, what information would be best

  4. 4.

    SelectWhatis best to say to whom you will disclose in describing:

    1. (a)

      Strengths and/or qualifications related to the job

    2. (b)

      Services provided to employer and/or employee (if available), benefits of disclosure and/or accommodations

    3. (c)

      Functioning in job performance affected by mental health condition or treatments

    4. (d)

      The mental health condition

      • A disability, a medical condition, an illness that is managed

      • A biochemical imbalance, neurological problem, a brain disorder

      • A mental health condition, psychiatric disorder, emotional condition

      • Recovered (In recovery) from a ____________ (use preferred term)

      • Difficulty with stress, personal problems, “get a little blue”

      • Other creative expression, or not mentioned at all

    5. (e)

      Solutions to the functional issues – accommodations or other supports (presented positively)

  5. 5.

    DetermineWhenis the best time to disclose

    1. (a)

      Before the interview (especially if accommodation needed in the interview, or if professional is involved with the employer)

    2. (b)

      During the interview (to explain gaps in work history, unusual circumstances, or visible signs of disability)

    3. (c)

      After the interview but before starting the job (when accommodations needed immediately upon starting the job)

    4. (d)

      Once on the job, before problems arise (when comfortable)

    5. (e)

      Later on the job, once the need for explanation of behavior or accommodations becomes known (last resort, may result in negative reactions of employer, potentially seen as an excuse if performance problems have arisen)

  6. 6.

    Research a list of the resources available to the employer if additional information about accommodations, documentation, or functional limitations is needed, such as:

    1. (a)

      Rehabilitation Counselor, Employment Specialist, Job Coach

    2. (b)

      Physician, Psychiatrist, Therapist, Counselor, Social Worker

    3. (c)

      Job Accommodation Network (JAN): 1-800-526-7234 orwww.jan.wvu.edu

    4. (d)

      ADA Disability and Business Technical Assistance Centers (DBTAC): 1-800-949-4232 orwww.adata.org

    5. (e)

      Other resources (seeResources on Disclosure and Accommodations)

  7. 7.

    Prepare professionals to provide documentation if requested (seeResources,JAN)

    1. (a)

      Nature of disability or mental health condition

    2. (b)

      Impact of disability on functioning, especially in extent of impact on major life activities (refer toResources, list of functional limitations, Bazelon Center for Mental Health Law)

    3. (c)

      Specific accommodations needed for limitations in functioning

  8. 8.

    Prepare and practice skills of disclosing and/or requesting accommodations

    1. (a)

      Prepare a script using comfortable language

    2. (b)

      Anticipate potential questions

    3. (c)

      Prepare responses to questions using positive terms, focusing on strengths and solutions

  9. 9.

    Practice with trusted significant others so it feels comfortable and makes a positive impression, communicating strength, competence, and ability to handle disabilities so they will not interfere with job performance.

    Example of disclosure: I am recovering from a medical condition that has been successfully treated. Currently, I am skilled in using Microsoft Office programs, answering phones, and scheduling appointments, but sometimes the medications that I take to maintain good health require using the restroom facilities every few hours. It would be helpful to have a 10-min break every 2 h, so I can manage this and do well in this job.

    • Adapted from: MacDonald-Wilson (2005,2008) and MacDonald-Wilson and Rea (2008)

Appendix C

Resources on Disclosure and Accommodations

ADA Disability and Business Technical Assistance Centers (DBTACs): 800-949-4232www.adata.org/. Ten regional centers provide information, technical assistance, and training on ADA and accommodations issues. The 800 number connects you directly to the DBTAC in your region.

Bazelon Center for Mental Health Law:www.bazelon.org. A legal advocacy organization for protection of the rights of people with mental illnesses and developmental disabilities. In addition to a variety of resources, information, and links, this site updates court decisions on the ADA and other laws.

Equal Employment Opportunity Commission (EEOC):www.eeoc.govor 800-669-3362. The government agency overseeing and interpreting the ADA. Materials and fact sheets available.

Frequently asked questions about employees with psychiatric disabilities: Tips and resources on the ADA, job accommodations, and supervision: Booklet for employers of people with psychiatric disabilities. Kim MacDonald-Wilson, Center for Psychiatric Rehabilitation, Boston University. Free download available fromwww.bu.edu/cpr/resources/articles/1997/macdonald-wilson1997.pdf.

Hyman I (2008)Self-disclosure and its impact on individuals who receive mental health services. HHS Pub. No. (SMA)-08-4337 Rockville, MD. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2008. Electronic access atwww.samhsa.gov. Free copies available at SAMHSA’s Health Information Network at 1-877-726-4727.

Job Accommodation Network (JAN):www.jan.wvu.eduor 1-800-526-7234. A free consulting service for employers, educators, and people with disabilities, which provides individualized worksite accommodations solutions and technical assistance on the ADA and other disability legislation. Additional specific resources on the web include SOAR (Searchable Online Accommodation Resource), fact sheets and examples, and forms such as Writing an Accommodation Request Letter and Sample Medical Inquiry Form.

Living Well with a Psychiatric Disability in Work and School – Center for Psychiatric Rehabilitation, Boston University – A website for employees and students with mental health disabilities with practical information and resources on the ADA, disclosure, and accommodations, including an interactive discussion board:www.bu.edu/cpr/jobschool. There is a related site for employers and educators atwww.bu.edu/cpr/reasaccom/.

National Collaborative on Workforce and Disability for Youth (2005)The 411 on disability disclosure workbook. Washington, DC: Institute for Educational Leadership. Available fromwww.ncwd-youth.info.

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MacDonald-Wilson, K.L. et al. (2011). Disclosure of Mental Health Disabilities in the Workplace. In: Schultz, I., Rogers, E. (eds) Work Accommodation and Retention in Mental Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0428-7_10

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