Psychiatric/Mental Health Disabilities

Disclosure of a psychiatric disability in supported employment: An exploratory study.

Banks, B., Novak, J., Mank, D. M., & Grossi, T. (2007). "Disclosure of a psychiatric disability in supported employment: An exploratory study." International Journal of Psychosocial Rehabilitation, 11(1): 69-84.

People with psychiatric disabilities entering the workplace and their supported employment providers frequently contemplate whether to disclose the supported employee’s disability and their support needs to employers and workplace personnel. This study examined the role of disclosing a psychiatric disability and the employment experiences of 162 people participating in ten supported employment programs in the United States. Results indicate that 82% of the supported employees had their disability disclosed in the workplace; however disclosure was typically made by the employment agency. The relation between who disclosed the disability, what was disclosed and the effect on employment outcomes (including typical employment experiences, job adjustment and workplace accommodations) are examined. Practical suggestions are identified for supporting individuals regarding disclosure.

Implementing reasonable accommodations using ADR under the ADA: The case of a white-collar employee with bipolar mental illness.

Blanck, P. D., Andersen, J. H., Wallach, E. J., & Tenney, J. P. (1994). "Implementing reasonable accommodations using ADR under the ADA: The case of a white-collar employee with bipolar mental illness." Mental & Physical Disability Law Reporter, 18(4): 458-464.

Presents the use of alternative dispute resolution (ADR) in the case of a senior account executive in a communications system company who developed bipolar mental illness. After 3 weeks of hospitalization, he returned to work. The actions of the company to provide reasonable accommodations for his disability are described. A consultant familiar with the Americans with Disabilities Act (ADA) helped the employee and his supervisor develop an accommodation plan which included a flexible work schedule. A co-worker was also assigned to travel with the employee during extended national sales campaigns. The company was saved the cost of training a replacement, and the cost of the ADA and medical consultants was far less than the costs of a lawsuit filed under the ADA. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Facilitators and barriers to employment among individuals with psychiatric disabilities: A job coach perspective.

Blitz, C. L., & Mechanic, D. (2006). "Facilitators and barriers to employment among individuals with psychiatric disabilities: A job coach perspective." Work: Journal of Prevention, Assessment & Rehabilitation, 26(4): 407-419.

Unemployment rates remain high among individuals with psychiatric disabilities despite growing evidence that supported employment programs (SEPs) can help such individuals to obtain and retain competitive employment. A complete understanding of factors that may facilitate or hinder the success of such supported employment efforts is urgently needed to increase the efficacy of SEPs and move more individuals with psychiatric disabilities from welfare to work. This exploratory study provides insight into potential facilitators and barriers to employment among individuals with psychiatric disabilities from the perspective of job coaches. Twenty-eight job coaches from 14 SEPs in a Northeastern state reported on their experience with four recent clients, two who were successful in obtaining employment and two who failed, through a semi-structured mail survey. Findings suggest that job coaches use similar strategies to assist clients, but in each case try to tailor specific strategies to client's needs and characteristics. Factors that influence successful job placement and research and policy implications are discussed. Copyright of Work is the property of IOS Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts)

Reasonable accommodations in the workplace for persons with affective mood disorders: A case study.

Coles, A. V. (1996). "Reasonable accommodations in the workplace for persons with affective mood disorders: A case study." Journal of Applied Rehabilitation Counseling, 27(4): 40-44.

Persons with a depressive disability experience difficulty in performance, absenteeism, productivity, and the possibility of frequent safety risks in the workplace. These behaviors are cognitive deficits of the illness but are often ignored by the helping professions when assisting clients with work related issues. The disability is intermittent in nature often requiring cognitive accommodations in the workplace. A case study interview with a 48 yr old White female supervisor with depression is used to identify specific emotional and behavioral barriers that have prevented clients from maintaining employment. Support mechanisms to reduce cognitive and behavioral deficits on the job are also presented. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Reasonable accommodations for workers with serious mental illness: Type, frequency, & associated outcomes.

Fabian, E. S., Waterworth, A., & Ripke, B. (1993). "Reasonable accommodations for workers with serious mental illness: Type, frequency, and associated outcomes." Psychosocial Rehabilitation Journal, 17(2): 163-172.

This paper reports on a study of reasonable accommodation for workers with serious mental illness undertaken at a community supported employment program in Bethesda, Maryland. The participants in the study consisted of 30 individuals who held a total of 47 jobs during the time frame of the study. Two hundred thirty-one accommodations at the worksite were identified for these individuals, for an average of 5.1 accommodations per job. The most frequently identified accommodation was Orientation and Training of Supervisors to provide necessary assistance (38.1%), followed by Modifications of the Non-physical Work Environment (16.4%); and Modifications of Work Hours and Schedules (15.69). Employment tenure was significantly associated with number of job accommodations.

Workplace accommodation as a social process.

Gates, L. B. (2000). "Workplace accommodation as a social process." Journal of Occupational Rehabilitation, 10(1): 85-98.

Successful sustained employment for people with disabilities is a function of a complex array of factors. Key among these factors is appropriate accommodation at the workplace. Current approaches to accommodation, however, are often unsuccessful. Research suggests that this is due, in part, to the limited view of accommodation as technical changes to the job. An approach to accommodation that does not take into account the social context ignores the consequences of the process on work group morale and individual self-esteem and well-being. This has repercussions for individual job performance, job satisfaction and work retention, as well as overall work group productivity. An intervention was designed to take into account the social nature of the accommodation process and pilot tested with 12 workers who were out on a short term disability leave with a psychiatric diagnosis and their work groups. Based on a psychoeducational model, the intervention educates the work group about what it means to work with a disability, provides a safe environment where the worker with disability and coworkers can share concerns about the impact of accommodation on the group, informs about the accommodation process and specifies strategies to help the worker with disability best meet job requirements. Key intervention components include 1) the development of a disclosure plan since workplace intervention cannot occur without disclosure, 2) a systematic method for identifying the work group members, 3) a formal psychoeducation training that includes the supervisor, identified work group members, and the individual in the work organization who has the authority to approve accommodations, and 4) on-going follow up support to the supervisor and worker with disability. Although generalizability of the findings is limited because of the small sample size and its application only to those with mental health conditions, they support the importance of this approach to employment outcomes for people with disabilities. First, findings suggest that the rehabilitation process cannot stop at placement. Providers must be willing and able to enter the workplace with their clients. This requires providers to take on new roles such as educators, interpreters, negotiators and trainers. Disclosure must lose its status as a taboo topic. Providers and workers with disabilities must come to understand the risks and benefits of disclosure, and, when the decision is made to disclose, must have a formal, structured plan for carrying it out. Finally, workplace intervention must take into account the social context and provide the opportunity for communication and interaction in order to insure the success of the accommodations

Relationship accommodations involving the work group: Improving work prognosis for persons with mental health conditions.

Gates, L. B., Akabas, S. H., & Oran-Sabia, V. (1998). "Relationship accommodations involving the work group: Improving work prognosis for persons with mental health conditions." Psychiatric Rehabilitation Journal, 21(3): 264-272.

This paper presents a workplace mapping technique that identifies work group members who should be targeted as part of an accommodation intervention strategy and describes its use with workers with mental health conditions, a group for whom relationship issues are often present in the work adjustment process. The technique was tested with 25 workers with a psychiatric disability. Results show that it is an important companion to the intake interview. It helps to focus on the workplace and clarifies a strategy for intervention by adding specificity about who offers the supports and which behaviors may serve as barriers that need to change. Case examples are provided and implications for successful employment discussed. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Knowledge and use of workplace accommodations and protections by young adults with schizophrenia: A mixed study.

Gioia, D., & Brekke, J. S. (2003). "Knowledge and use of workplace accommodations and protections by young adults with schizophrenia: A mixed study." Psychiatric Rehabilitation Journal, 27(1): 59-68.

Discusses a mixed method study aimed at eliciting understanding of the knowledge and use of the provisions of the Americans with Disabilities Act (ADA) from 20 persons with schizophrenia who returned to work. Role of ADA in influencing the employment of recovered schizophrenics; Use of ADA provisions; Patients need and comfort with ADA opportunity.

The disclosure conundrum: How people with psychiatric disabilities navigate employment.

Goldberg, S. G., Killeen, M. B., & O'Day, B. (2005). "The disclosure conundrum: How people with psychiatric disabilities navigate employment." Psychology, Public Policy, and Law, 11(3): 463-500.

The vocational rehabilitation and mental health literatures usually urge people with psychiatric disabilities to disclose their disability at work. Reasons for preferring disclosure include the opportunity to invoke rights conferred by the Americans with Disabilities Act of 1990, the risk of losing federal disability benefits when earning a higher income, and the belief--held by many professionals--that people with psychiatric disabilities will experience permanently debilitating symptoms. However, a newer model of recovery from psychiatric disability challenges these assumptions. A qualitative study of people with psychiatric disabilities explored these issues. The participants were current or former recipients of social security benefits provided to persons with significant disabilities. Participants described complex situations around employment and disclosure, which were more difficult to resolve than disclosure advocates have recognized. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

The role of psychiatric rehabilitation practitioners in assisting people in understanding how to best assert their ADA rights & arrange job accommodations.

Granger, B. (2000). "The role of psychiatric rehabilitation practitioners in assisting people in understanding how to best assert their ADA rights and arrange job accommodations." Psychiatric Rehabilitation Journal, 23(3): 215-223.

Findings from focus groups indicate personal need for education and skills related to decisions about their ADA rights, job accommodations, disclosure and negotiation. Authentic empowerment emerges when practitioners replace their job and maintenance perspective with a teaching, skills development and peer support perspective to achieve independent career decision making over the long term.

Findings from a national survey of job coaches & job developers about job accommodations arranged between employers & people with psychiatric disabilities.

Granger, B., Baron, R., & Robinson, S. (1997). "Findings from a national survey of job coaches and job developers about job accommodations arranged between employers and people with psychiatric disabilities." Journal of Vocational Rehabilitation, 9(3): 235-251.

Describes the method and results of a mailed survey completed by 194 job coaches and job developers who serve people with psychiatric disabilities. Job accommodations used most frequently include use of the job coach in facilitating communications, phone access to the job coach, use of positive feedback, option for part-time work and gradual task introduction. Costs for job accommodations for people with psychiatric disabilities are low. Disclosure takes place more often before the job offer where job coaches are involved. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Reasonable accommodation for employees with mental disabilities: A mandate for effective supervision?

Hantula, D. A., and Reilly, N. A. (1996). "Reasonable accommodation for employees with mental disabilities: A mandate for effective supervision?" Behavioral Sciences & the Law, 14(1): 107-20.

Reasonable accommodation under Title I of the Americans with Disabilities Act (ADA) for employees with mental disabilities is explored from a behavior analytic perspective. Although much of the attention in issues of reasonable accommodation is concentrated on persons with physical disabilities, it is argued that the needs of individuals with mental disabilities are in greater need of further study. The criteria for successful accommodation in the workplace for employees with mental disabilities is seen to be structurally different, but functionally similar to successful accommodations for employees with physical disabilities, and is based on the development of enabling environments. Behavior analysis offers a theoretical basis and performance management presents a methodological basis for analyzing, developing, implementing, and evaluating reasonable accommodation for persons with mental disabilities, largely in terms of effective supervision. It is concluded that Title I of the ADA may be seen as providing a mandate for effective supervision, which may also be extended to all employees.

Assessment of employees with mental health disabilities for workplace accommodations: Case reports.

Houlihan, J. P., & Reynolds, M.D. (2001). "Assessment of employees with mental health disabilities for workplace accommodations: Case reports." Professional Psychology: Research and Practice, 32(4): 380-385.

Psychologists who work with employers are increasingly being asked to play a role in developing accommodations for workers with mental health disabilities that conform to the provisions of the Americans with Disabilities Act (1992). Using 6 representative cases referred for accommodation evaluation at a federal agency, this article examines the common practical problems that arise when attempting to implement reasonable accommodations in an organizational work setting. It concludes that maintaining good communication among employees, employers, case managers, and outside treatment providers increases the likelihood of a successful outcome. The article also outlines procedures for conducting workplace accommodation evaluations and suggests strategies to consider when providing this type of consultation. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Reasonable accommodation to mental health disabilities at work: Legal constructs & practical applications.

Kaufmann, C. L. (1993). "Reasonable accommodation to mental health disabilities at work: Legal constructs and practical applications." The Journal of Psychiatry & Law, 21:153-174.

Title I of the ADA of 1990 requires employers to make reasonable accommodations to workers with physical and mental health disabilities. The linking of physical and mental illnesses under a common mandate confuses many employers and their legal advisors. Mental illnesses usually manifest themselves through behavior, and the accommodations required involve adjustments in scheduling, supervision, and interpersonal relationships on the job. This paper presents case studies in reasonable accommodation to workers with schizophrenia. The most common accommodation is flexible scheduling to allow for psychiatric treatment during work hours. Second most common is adaptations of the interpersonal environment to protect the worker's privacy and reduce stress. Cases of successful and unsuccessful outcomes to the accommodation process indicate that some functional limitations cannot be accommodated. For an accommodation to be reasonable, it must meet the needs of the employers as well as the worker. While not all persons with mental health disabilities meet qualifications for jobs in the competitive labor force, many function well with minimal adjustments from an employer.

An investigation of reasonable workplace accommodations for people with psychiatric disabilities: Quantitative findings from a multi-site study.

MacDonald-Wilson, K. L., Rogers, E. S., Massaro, J. M., Lyass, A., & Crean, T. (2002). "An investigation of reasonable workplace accommodations for people with psychiatric disabilities: Quantitative findings from a multi-site study." Community Mental Health Journal, 38(1): 35-50.

Despite the requirement of many employers to provide accommodations in the workplace for individuals with disabilities under Section 504 of the Rehabilitation Act of 19673, the preponderance of accommodations that have been described in the literature concern physical rather than psychiatric disabilities. This study was an exploratory, descriptive, longitudinal, multi-site investigation of reasonable workplace accommodations for individuals with psychiatric disabilities involved in supported employment programs. We discuss the functional limitations and reasonable accommodations provided to 196 participants and the characteristics of 204 employers and 22 service provider organizations participating in the study. Implications for service providers and administrators in supported employment programs are discussed.

Identifying relationships between functional limitations, job accommodations, & demographic characteristics of persons with psychiatric disabilities.

MacDonald-Wilson, K. L., Rogers, E. S., & Massaro, J. (2003). "Identifying relationships between functional limitations, job accommodations, and demographic characteristics of persons with psychiatric disabilities." Journal of Vocational Rehabilitation, 18(1): 15-24.

Years after the passage of the Americans with Disabilities Act, little empirical information exists about the relationship between the functional limitations experienced by individuals with psychiatric disabilities, and related reasonable accommodations provided on the job. A multi-site, longitudinal study was conducted with 191 employees in 22 supported employment programs across 3 states during a 1-year study period. Data were gathered prospectively in a structured, narrative form designed to describe both the functional limitations and accommodations of participants. The most frequent functional limitations among this group of employed persons with psychiatric disabilities were cognitive in nature, followed by social, physical, and emotional/other. There was a significant relationship between the type of functional limitation and the number and type of accommodations received. There was a marginally significant relationship between type of functional limitation and a diagnosis of schizophrenia. There were no significant relationships between any other clinical or demographic factors, functional limitations or reasonable accommodations. Cognitive limitations were the most prevalent in this sample and the best predictor of the number of accommodations provided. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Cultural & organizational aspects of application of the Americans with Disabilities Act to persons with psychiatric disabilities.

Mechanic, D. (1998). "Cultural and organizational aspects of application of the Americans with Disabilities Act to persons with psychiatric disabilities " The Milbank Quarterly, 76(1): 5-23.

The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodation for persons with psychiatric disabilities. Most persons with a history of mental disorder work productively and do not require accommodation. Many persons with serious mental illness need accommodation but are conscientious and productive workers. Difficulties inherent in the Equal Employment Opportunity Commission (EEOC) guidelines are those of differentiating aspects of mental disorder from work-related conduct and the potential for manipulative persons to use the Act to excuse inappropriate behavior and ask for accommodation. A further problem is the potential for discouraging employers from hiring persons with mental illness because of the perceived difficulty of terminating them should their work prove unsatisfactory. If the ADA is to be effective, it must be seen as only one step in a larger process involving public education, effective mediation, and meaningful assistance.

The dynamics of disclosure: Its impact on recovery & rehabilitation.

Ralph, R. (2002). "The dynamics of disclosure: Its impact on recovery and rehabilitation." Psychiatric Rehabilitation Journal, 26(2): 165-172.

Disclosure of one's own experiences with psychiatric disability can be both exhilarating and depressing. This article shares experiences of the author and others in their disclosure, and provides some ideas about the risks and benefits of disclosure.

Scheid, T. L. (1999). "Employment of individuals with mental disabilities: Business response to the ADA's challenge." Behavioral Science & the Law, 17(1): 73-91.

This research examines the response of the business community to the Americans with Disabilities Act (ADA) with specific focus on the employment of those with mental disabilities. The ADA is viewed as an important rational myth in that it represents both a legal and normative demand with which businesses are expected to comply. Yet employers' responses will be influenced by their attitudes toward persons with mental disabilities as well as their concern with legal sanction for discriminatory behaviors. A telephone survey was completed in a southern metropolitan area with a random sample of 117 businesses in order to access the knowledge employers have about the ADA (and its inclusion of those with mental disabilities), the compliance with the ADA, the employment practices, and the role played by stigma in the employment of individuals with mental disabilities. In terms of specific practices which indicated compliance with the ADA, a little over one-third of the companies which were surveyed by telephone had a Title 1 implementation plan, 15% had specific policies for hiring those with mental disabilities, and 37.6% had indeed hired such an individual. The role of coercive and normative rationales for compliance to the ADA was examined. It was found that receiving formal information about the ADA, threat of legal sanction, and previous employment of those with mental disabilities were all significant predictors of compliance with the ADA. Stigmatizing attitudes did not predict compliance, though employers did view those with mental disabilities with more discomfort than other types of employees. Copyright © 1999 John Wiley & Sons, Ltd.

Organizational response to employment under the ADA of workers with psychiatric disabilities: Four case studies.

Scott, P. J. (1997). "Organizational response to employment under the ADA of workers with psychiatric disabilities: Four case studies." Dissertation Abstracts International Section A: Humanities and Social Sciences, 58(3-A): 1086.

Title 1 of the Americans with Disabilities Act (ADA) requires all employers, public and private, with more than fifteen employees to provide reasonable accommodation to qualified individuals with disabilities if the accommodation would, within limits, allow the individual to perform the essential functions of the job. Seven years after Congress enacted the law and five years after the initial provisions became effective, little information is available about the experience of organizations faced with requests for workplace accommodation. The question addressed in this study is: How are organizations responding to the ADA mandate to fit individuals with psychiatric disabilities in the workplace? The data sources are three organizations that allowed access to this sensitive information, and a fourth that had two disability discrimination charges filed against it. A brute-force case method approach applied to the four organizations yields the following information: Attorneys are hesitant to allow inquiry into company policy owing to fear of litigation; workers are not disclosing and requesting accommodation; tacit accommodation of long-standing employees appears to be a regular practice; knowledge of the intent of the ADA makes a difference in terms of equality of treatment; and insensitivity to employee privacy results in an adversarial situation. Implications are relevant to the need to improve lines of communication between human resource, EEO, supervisory, and legal staff; consequences of failure to address accommodations on an explicit level; need for better understanding of the availability and use of outside resources for achieving accommodation; and improvement of self-advocacy and disclosure by the employees with disabilities.

Individual & job site factors in the development of reasonable accommodations for workers with schizophrenia.

Symanski-Tondora, J. L. (2003). "Individual and job site factors in the development of reasonable accommodations for workers with schizophrenia." Dissertation Abstracts International: Section B: The Sciences and Engineering, 63(8-B): 3942.

The Title I provisions of the Americans with Disabilities Act (ADA, 1990) have had minimal impact on the growth of equal opportunities for people with serious psychiatric disabilities who wish to attain competitive employment. While some attention has been paid to the "reasonable accommodations" clause of the ADA as it pertains to individuals with physical disabilities, the role of such accommodations in facilitating workplace integration for people with psychiatric disabilities has been a largely neglected area. If the vision of the ADA is to be realized, clinical and vocational rehabilitation professionals must provide empirical evidence and professional recommendations regarding what really works, and for whom, in regard to modifications in the employment arena. This study examines how individual characteristics (e.g., cognitive impairment, baseline work functioning, clinical symptomatology) and work site characteristics (i.e., site complexity) impact the need for reasonable accommodations among a sample of 87 participants with schizophrenia or schizoaffective disorder in an ongoing Work Rehabilitation study at the West Haven Veterans Affairs Medical Center. Findings from the current study regarding frequently employed accommodations replicate prior research on this topic and highlight the role of the following accommodations: establishing flexible schedules and leave policies, allowing the employee to have telephone access to his/her therapist, accepting a longer learning period, creating an initial job "match" based on the employee's strengths and needs, and allowing the employee more time to complete tasks. Significant between-group differences across various study groups of interest support the fundamental hypothesis of the current research, i.e., that accommodations are not "generic" to all persons with psychiatric disabilities, but rather, they can, and should, take into consideration both characteristics of the job site and unique personal characteristics, in particular an individual's baseline work behavior. Finally, this study presents compelling evidence for the need of clinical and rehabilitation professionals to attend to an individual's interpersonal skills, rather than his/her specific work quality or habits, when designing reasonable accommodations.