What is the concept of workforce reentry for employees with mental disorders?

Introduction

The unemployment rate for individuals with persistent mental illness is estimated to be as high as 90 percent, even when these individuals want to work or are able to work. With treatment, many people have manageable symptoms or recover from their disease, and can lead productive lives. Reintegration into society, including a return to the workforce, is a priority of mental health management. Work is an important step in becoming self-reliant and provides a focus away from the mental illness.

Research has demonstrated that there is no significant difference in the productivity of employees with and without mental illness. In 1990, President George H. W. Bush signed into law the Americans with Disabilities Act (ADA), which prohibits discrimination against people with a variety of disabilities, including psychiatric disabilities, in employment and other services. Under the ADA, reasonable accommodations are required when workforce reentry occurs. In 1999, President Bill Clinton signed legislation to eliminate work disincentives called the Ticket to Work and Work Incentives Improvement Act. The act provided people with disabilities the opportunity to pursue a job without losing health care coverage.

The ADA defines a disability as a physical or mental impairment that substantially limits major life activities, including work. Mental impairment may be any mental or psychological disorder, including emotional or mental illness such as depression, anxiety disorders, schizophrenia and personality disorders. Addictions to drugs or alcohol are also impediments to workforce reentry. Employers should define a program to enable potential and existing employees with mental health issues to reenter the workforce.

Implications for Employers

The cost of care for mental-health-related conditions is often the highest percentage of health care insurance dollars spent by a company, according to the Partnership for Workplace Mental Health: A Program of the American Psychiatric Foundation. Managing the employee’s return to work after mental health care ensures that the dollars spent were worthwhile. The goals for employers are to improve and maintain the employee’s outcomes of treatment, decrease future absenteeism, and minimize the cost and impact of behavioral health conditions on the workplace and the employee’s colleagues.

Regardless of the underlying cause of mental illness, an employee’s return to work poses a challenge to coworkers and supervisors. Behavioral health problems, poor self-esteem and work habits, and fear of the work environment may cause the employee to stay away from work longer than necessary, increasing the workload for coworkers. Colleagues may grow to resent the employee because of frequent absences. The same stigma attached to mental illness that prevents individuals from seeking care may also negatively affect coworkers’ support for the returning employee if they know why the coworkers was absent. If the workplace and colleagues are unprepared to provide necessary support, the stress of returning to work may prevent the affected individual from moving into an environment that will enhance recovery.

To enhance assimilation of the employee into the workforce, a program designed to support reentry while minimizing disruption is critical. The company’s leadership must communicate a clear message of a nondiscriminatory workplace, whether illness is physical or mental. Supervisors are essential to a successful employee reentry and must receive education and training to understand their role. All employees must be educated to issues surrounding mental health and the need to seek care for mental health issues promptly. A greater understanding of mental health issues by employees in the workplace encourages a climate of acceptance and support should the returning employee choose to share personal information.

Employers are also required by the ADA to hold all information about the employee reentering the workforce in strict confidence. Supervisors and select others may receive information necessary to manage the work and needs of the returning employee. The employer is also not allowed to disclose any medical information about the returning employee to coworkers. If employees question why the returning worker is receiving different or special treatment, the employer can only state that it is acting in compliance with a federal law for legitimate business reasons.

Reasonable Accommodations

The ADA requires reasonable accommodations for individuals with disabilities. Changes to workplace policies, procedures or practices that are not excessive in cost or disruption are expected. Changing a schedule to allow the returning employee to gradually increase to full-time work or to carpool if unable to drive; providing a quiet workspace to minimize sensory stimulation, such as for the employee with severe attention deficit disorder; and providing time off for recurrent physician visits are examples of reasonable accommodations. Employers are not expected to make changes that are an undue hardship or to allow a disruptive or threatening employee to return to the workforce, but a health care professional must participate in the decision to refuse workforce reentry.

Successful reentry into the workplace requires trust and a partnership between the employer and employee. Open, honest communication and dialogue will facilitate the reentry process.

Bibliography

Corrigan, Patrick W., David Roe, and Hector W. H. Stang. Challenging the Stigma of Mental Illness: Lessons for Therapists and Advocates. Chichester: Wiley, 2011. Print.

Kessler, R. C., et al. “Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers.” American Journal of Psychiatry 163 (2006): 1561–68. Print.

Lengnick-Hall, Mark L., ed. Hidden Talent: How Leading Companies Hire, Retain, and Benefit from People with Disabilities. Westport: Praeger, 2007. Print.

Lloyd, Chris. Vocational Rehabilitation and Mental Health. Chichester: Wiley, 2010. Print.

National Council on Disability. Implementation of the Americans with Disabilities Act: Challenges, Best Practices, and New Opportunities for Success. Washington, DC: Author, 2007. Print.

OECD. Sick on the Job?: Myths and Realities about Mental Health and Work. Paris: Author, 2012. Print.

Rubin, Stanford E., and Richard T. Roessler. Foundations of the Vocational Rehabilitation Process. 6th ed. Austin: PRO-ED, 2008. Print.

Warren, Frank, and Richard G. Luecking. Jobs for People: A Handbook—Finding Employment Opportunities for Citizens Who Have Disabilities. Rockville: TransCen, 1989. Print.