Mental Illness Stigma and Work

Work is an activity central to lives and well-being of most of us. Employment is, of course, a route to income and therefore to the goods and services we desire for a satisfying life. Even more importantly, work, whether paid or unpaid, contributes significantly to self-esteem, confirming that one is a productive and valued member of society. For people recovering from mental illness, it may also be an opportunity for community connection and a source of needed routine and structure.

Unfortunately, the benefits of work are often undermined by the stigma that accompanies a diagnosis of mental illness. Mental illness stigma refers to the negative attitudes that the public holds about people with psychiatric disorders. Social science research has shown that being given a psychiatric diagnosis — or even being involved in some form of mental health treatment — can lead to unflattering assumptions about the competence, character, and potential of the person so labeled. These inaccurate assumptions include stereotypes associated with mental illnesses, particularly severe mental illness. The public may believe that people who suffer from mental illness:

• never recover enough to become contributing members to their communities,
• are fundamentally unstable and unpredictable,
• may be dangerous to those around them.

Such negative expectations can lead to behavior and policies that interfere with mental health consumers opportunities to participate in the community, function as workers and prosper.

Stigmas effect on efforts to work

Prospective employers, incorrectly believing that people with mental illness are unlikely to be good workers, are reluctant to hire individuals with histories of psychiatric diagnosis or treatment. As a consequence, those with such histories may have difficulty in obtaining work. In a recently-conducted study, our research team at George Mason University sought information from mental health consumers about their experiences of stigma and discrimination. We heard from over 1400 consumers from all 50 of the United States and three foreign countries, and we interviewed 100 of them at length. Nearly half reported that they were currently unemployed and about one third indicated that they had experienced being turned down for jobs for which they were qualified when their status as a mental health consumer was revealed. “I applied for employment at a well-known national engineering company,” one person recalled, “and received a job offering with the condition that I bring a work release note from my doctor. (The company knew that I had not been working due to an [unspecified] illness.) When I gave them the note stating that I was mentally ill but could now work, they discovered they could no longer afford to hire me.”

Even those who try to make contributions to their communities through unpaid work may be met with restrictive policies against mental health consumers. Attempts to volunteer ones time and effort may be blocked because many agencies have clear rules prohibiting the involvement of anyone with a mental health treatment history. One of our study participants, who worked as the Family and Community Involvement Coordinator for a small school district and who had won previous awards for her work with youth, told us how she was arranging to accompany a group of students to a YMCA Young Leaders Program when she encountered a roadblock. “You cannot imagine my shock and anger,” she recalled, “when I reached the part on the volunteer staff application that reads: Please note that volunteers who are being treated for any emotional or mental illness will not be admitted.” Even in the mental health field, where there should be a better understanding of the potential of mental health consumers to make valuable contributions, blanket prohibitions against those with psychiatric histories are common. As one woman reported: “I tried to do volunteer work at a sheltered workshop. They said, We have standing policies that no clients, active clients or former clients up to five years after the fact, can volunteer.” Still another consumer described this experience: “After I got my Masters Degree in Social Work, I wanted to volunteer at this one counseling clinic…and they would not let me volunteer because of my history, regardless of my therapeutic skills and credentials and education or whatever. They just said, No. You have a history of depression. You have a history of being unstable. We cannot allow you to volunteer here.”

Stigma within the workplace

Those who are successful in obtaining employment or who already have jobs may also be affected by stigma. They may find themselves demoted, for example, or relegated to positions of lesser responsibility once their superiors learn that they have been receiving mental health treatment. “When I was first diagnosed,” wrote one respondent in our survey, “I made the mistake of telling my supervisor at the time what was going on. She decided I couldnt handle a job Id been doing for ten years and demoted me.” Another reported: “I worked in schools, as a school psychologist. I never told ahead of time [about my mental illness], but if hospitalized subsequently, there were often detrimental repercussions, such as being fired or put on probation.”

Still another consumer recounted the following incident: “In August of 1995, within one week of returning from a leave of absence for treatment of depression, I was encouraged by [my supervisor] to voluntarily resign my nursing position, which I had held for nine years. She said, Mental illness makes people squeamish. Although neither my doctor nor I had any questions regarding my ability to safely carry out my duties, she also then said that…she could guarantee me that I wasnt going to be able to cut the mustard.”

For those with psychiatric disorders, the work environment can also turn into an experience of alienation and isolation that makes both employment and recovery difficult to sustain. Too often, our study participants indicated that co-workers responded to knowledge of their psychiatric disorders with discomfort, avoidance, and even fear. As one consumer explained: “Ive seen some people shy away from my work area”.Instead of walking past [my] work area to their desk, theyd walk around [the] work area, take a slightly longer route to get to their desk because, telling by their body language, theyre afraid of the nuts at one end of the office.” Another noted: “At work, they may say good morning or hi, but I am never asked to social gatherings outside of work. People think I am defective or that I may become violent or something”.It hurts to be treated as a non-person.”

The solution to the problem of stigma in the workplace chosen by many of the consumers from whom we heard was to conceal their psychiatric disorders from employers and co-workers. Unfortunately, this solution brings with it many additional stresses. Many consumers go to elaborate lengths to conceal illness and treatment, paying out-of-pocket for treatment expenses rather than using insurance provided through employers, traveling many miles away from their home communities to seek treatment, and creating a repertoire of plausible excuses for absences from work to see therapists. Moreover, these consumers live with persistent worry that someone will find out their secret and that they will experience rejection, demotion, and discrimination. To the burden of mental illness, then, is added continual anxiety about possible discovery.

In addition, the need to protect themselves from workplace stigma and discrimination may prevent those struggling with mental disorders from obtaining many of the supports needed for full recovery. As noted previously, concealment means that consumers will be unable to utilize employer-provided insurance coverage for treatment, resulting in treatment that is limited to what they can personally afford rather than what is needed. Furthermore, those who conceal their illness from employers cannot ask for accommodations, such as time off for appointments, or for the potentially valuable emotional support of their co-workers during difficult times in their illness.

What you can do in your community

• Change your expectations about the capabilities and potential of people who have mental illness. Even mental health caregivers sometimes still cling to outdated notions that those with serious mental illness are unlikely to recover sufficiently to manage competitive employment. Ample research, however, now demonstrates that with improved medications and adequately funded, person-centered community programs, successful and lasting employment is a reasonable goal even for those dealing with serious and persistent mental illness.

• Educate employers about mental illness. Meet and talk with employers and help them appreciate that psychiatric labels tell us little about a persons capacity for friendship or creativity, or job success. Help them understand that the vast majority of people who have mental illness, including severe illness such as schizophrenia, are neither violent nor dangerous. Familiarize them with the research findings that demonstrate that those with mental illness can and do make reliable, productive employees.

• Make clear that denial of employment based solely on knowledge of mental illness or psychiatric treatment is discrimination — just as surely as job denial based on race or gender is. Speak out about such discrimination. Push for political or legal statements, such as the Americans with Disabilities Act in the United States, that make such discrimination clearly illegal.

• Provide supports for people with mental illness on the job. These may include flexible hours, modified work environments, and time off for treatment appointments — similar to accommodations that might be made for employees recovering from physical illnesses or injuries. Employers might also provide education to workers about mental health issues, helping to create a more accepting and supportive environment in which problematic concealment of mental illness is not necessary.

• Treat co-workers recovering from mental illness as you would colleagues recovering from any other illness. Do not exclude or avoid them. Do not hesitate to inquire as to how they are doing, or to ask about their illness and treatment. If they have had to miss work, let them know that you are pleased to see them back. Ask them if there is anything you can do to help. And above all, heed the advice of the mental health consumer in our study who urged: “Whenever you hear that somebodys got a mental illness, dont act like theyre worthless or theyre no good anymore — theyre ruined. Esteem them as valuable human beings.”

Material on mental illness stigma and work was prepared in consultation with Otto F. Wahl, Ph.D. Dr. Wahl is the author of Telling Is Risky Business: Mental Health Consumers Confront Stigma (Rutgers University Press) in which mental health consumers describe their experiences of stigma, and of Media Madness: Public Images of Mental Illness (Rutgers University Press), which examines the nature and impact of mass media depictions of mental illness. For further information, contact Dr. Wahl at Department of Psychology, George Mason University, Fairfax, VA 22030 USA. You may also reach him by e-mail at [email protected] or visit his internet site at http://mason.gmu.edu/~owahl/INDEX.HTM