Mental Illness and Employment Discrimination

Heather Stuart

Disclosures

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

In This Article

Stigma and Employment Equity

Past research has shown that most people with serious mental disorders are willing and able to work.[8,13] Yet, their unemployment rates remain inordinately high. For example, large-scale population surveys have consistently estimated the unemployment rate among people with mental disorders to be three to five times higher than their nondisabled counterparts. Sixty-one percent of working age adults with mental health disabilities are outside of the labour force, compared with only 20% of working-age adults in the general population.[14*] Employment rates also vary by diagnostic group from 40 to 60% for people reporting a major depressive disorder to 20-35% for those reporting an anxiety disorder. Unemployment rates for people with serious and persistent psychiatric disabilities (such as schizophrenia) are the highest, typically 80-90%.[15] As a result, people with serious mental disabilities constitute one of the largest groups of social security recipients.[16*,17**]

Stigmatizing views held by employers make it difficult for people with mental disabilities to enter the competitive workforce. Employers are more likely to hire someone with a physical disability,[18] thus raising doubts about the effectiveness of disability quotas as a method of affirmative action for people with mental disorders. Surveys of US employers show that half of them are reluctant to hire someone with past psychiatric history or currently undergoing treatment for depression, and approximately 70% are reluctant to hire someone with a history of substance abuse or someone currently taking antipsychotic medication.[19] Half would rarely employ someone with a psychiatric disability and almost a quarter would dismiss someone who had not disclosed a mental illness.[20] It is important to note that these behaviours are in direct contravention to the Americans with Disability Act, which requires employers to make reasonable workplace accommodations for people with physical and mental disabilities.[21*]

People with mental disorders identify employment discrimination as one of their most frequent stigma experiences.[22*,23] Compared with individuals with physical disabilities, twice as many people with mental disabilities (the majority) expect to experience employment-related stigma.[23] One in three mental health consumers in the United States report being turned down for a job once their psychiatric status became known and in some cases, job offers were rescinded when a psychiatric history was revealed.[24,25] In Canada, 78% of consumers participating in a membership survey conducted by the Canadian Mental Health Association identified employment as one of the areas most affected by stigma.[26] Fear of stigma and rejection by prospective employers may undermine confidence and result in a poorer showing on job interviews. Over time, people with mental disorders may come to view themselves as unemployable and stop seeking work altogether.[24,27]

Having a psychiatric diagnosis can also seriously limit career advancement as employers are less likely to hire people with mental disorders into executive positions.[28] Research shows that people with psychiatric diagnoses are likely to be underemployed, in lower paying menial jobs or in jobs that are incommensurate with their skills and interests.[24,29*] Of the 4600 people receiving supported employment in the State of Indiana, for example, only about one in 10 of the 66% who were employed after 3 months of service were employed in professional or technical jobs. Nine out of 10 were employed in lower paying jobs with poor benefits.[30*]

Much research shows that people with mental disabilities are more likely to be hired into the secondary labour market where jobs are unskilled, part-time and temporary, with high turnover and few benefits. Economic incentives for people with mental disorders to work full-time in the primary labour market are minimal. The money that they make often displaces or jeopardizes their disability benefits, creating a benefit trap.[31,32] Two recent studies[29*,33*] confirm that people with mental disorders who receive disability payments are less likely to be employed competitively and, if employed, likely to earn less. Participation in the secondary labour market may also be a function of a lack of education and training due to illness-related interruptions. If so, greater attention to helping people with mental disabilities advance their education and training, rather than focusing on immediate employment - the remit of most supported employment programmes[14*,34*,35*] - may reduce underemployment and improve job tenure.[17**]

Employees with mental health problems may also experience stigma and discrimination from coworkers once their mental illness becomes known. Workers who return to their jobs after an illness report returning to positions of reduced responsibility with enhanced supervision where they are socially marginalized and become targets for mean-spirited or negative comments from workmates who had previously been supportive and friendly.[24,25,36] Half of the competitive jobs acquired by people with a serious mental illness will end unsatisfactorily as a result of problems that occur once the job is in progress, largely as a result of interpersonal difficulties.[37]

In order to avoid workplace stigma and discrimination, employees with mental health problems will usually go to great lengths to ensure that coworkers and managers do not find out about their illness, including avoiding employee assistance programmes and shunning effective treatment options. Indeed, the majority of employees who have mental health problems will fail to receive appropriate treatment.[26] For example, only about a third of employees with depression will consult a mental health professional, physician or employee assistance programme and as few as one in 10 of those who report occupational impairment will take medication to address this problem. Yet, the majority of those who are appropriately treated for depression will manifest improved work performance and reduced disability days sufficient to offset employer costs for treatment.[38] Compounding this problem is the fact that few managers have sufficient knowledge to recognize or skills to effectively manage mental health problems at the workplace. Similarly, few organizations have corporate plans to address workplace mental health and employment equity for people with mental disabilities.[39,40,41] To reduce stigma and discrimination associated with mental disorders and promote employment equity for people with mental disabilities, organizations will need to be proactive in identifying and managing mental health problems among their workers and in fostering an organizational culture that is supportive of mental health and psychosocial recovery.[42*,43*]

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