Mental Illness and Employment Discrimination

Heather Stuart

Disclosures

Curr Opin Psychiatry. 2006;19(5):522-526. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: Work is a major determinant of mental health and a socially integrating force. To be excluded from the workforce creates material deprivation, erodes self-confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability. This review summarizes recent evidence pertaining to employment-related stigma and discrimination experienced by people with mental disabilities. A broad understanding of the stigmatization process is adopted, which includes cognitive, attitudinal, behavioural and structural disadvantages.
Recent Findings: Stigma is both a proximate and a distal cause of employment inequity for people with a mental disability who experience direct discrimination because of prejudicial attitudes from employers and workmates and indirect discrimination owing to historical patterns of disadvantage, structural disincentives against competitive employment and generalized policy neglect. Against this background, modern mental health rehabilitation models and legislative philosophies, which focus on citizenship rights and full social participation, are to be welcomed. Yet, recent findings demonstrate that the legislation remains vulnerable to the very prejudicial attitudes they are intended to abate.
Summary: Research conducted during the past year continues to highlight multiple attitudinal and structural barriers that prevent people with mental disabilities from becoming active participants in the competitive labour market.

Introduction

Stigma can be defined narrowly as a prejudicial attitude attributed to people who have a mental illness that may result in discriminatory practices,[1] or it can be used to reflect a broader social process with cognitive, attitudinal, behavioural and structural elements that interact to create and perpetuate social inequities, discriminatory treatment and disadvantage of people who have a mental disorder.[2] This review summarizes recent evidence pertaining to employment-related discrimination experienced by people with mental disabilities, using the broader understanding of the stigmatization process as it is more consistent with the day-to-day experiences of people who live with a mental disorder, the wide variety of intervention approaches used to combat stigma and discrimination,[3,4**] and the growing interest in human rights and social entitlements for people with mental disabilities.[5*]

Work is a major determinant of mental health and a socially integrating force that is highly valued. No single social activity conveys more of a sense of self-worth and social identity than work. To be excluded from the workforce not only creates material deprivation but also erodes self-confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability. For people with a serious mental disorder, employment is an important stepping-stone to recovery. It is a normalizing factor that provides daily structure and routine, meaningful goals, improves self-esteem and self-image, increases finances, alleviates poverty, provides opportunities to make friendships and obtain social support, enriches quality of life and decreases disability. People with mental disorders who are unemployed and who lack meaningful social roles are in a position of double jeopardy; on the one hand, being stigmatized because of their mental disorder (making it harder to gain competitive employment) and on the other hand, being stigmatized for their lack of occupation.[6,7,8]

Historically, competitive employment has not been a major focus of the mental health system. There has been a tendency to adopt minimal expectations and lower standards of achievement for people with a mental disorder. Sociostructural barriers and disincentives have also made it difficult for people with a mental disorder to get in and stay in the competitive workforce.[9] Modern mental health treatment philosophy is, however, based on the premise that people with mental disorders have the right to live and work in the community. To realize these goals, people with mental disorders must be able to access appropriate community-based treatment and rehabilitation services and safe and affordable housing and should have equal access to employment opportunities that are commensurate with their skills, interest and training. All too often, stigma, expressed through a lack of political commitment to provide adequate services, community intolerance towards mentally ill people and employment inequity, makes this impossible.[10] As stigma is so pervasive and the consequences so profound, international organizations such as the World Health Organization and the World Psychiatric Association have identified stigma related to mental illness as the most significant challenge facing the field of mental health today.[11,12]

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