Fair Employment Practices_________________________________________________April 7, 1994

Accommodating Mental Illnesses in the Workplace

Some 10.2 percent of EEOC charges filed under the Americans With Disabilities Act between July 26, 1992, and January 31, 1994, claimed bias based on mental illness. A new resource, The ADA and People With Mental Illness , by Deborah Zuckerman, Kathleen Debenham, and Kenneth Moore offers help for employers in understanding mental illness and complying with the law.

What is Mental Illness?

The authors discuss mental illness, one type of mental impairment covered under ADA. They exclude mental retardation, alcoholism, organic brain damage, and learning disabilities and focus on the most common mental illnesses as categorized by the American Psychiatric Association.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) is published by the APA to diagnose mental disorders. It refers to three types of mental illnesses; (1) anxiety disorders, including phobias, panic disorders, obsessive-compulsive disorders, and post-traumatic stress disorder; (2) depressive disorders, which are mood disorders; and (3) schizophrenia, which is characterized by dissociated or fragmented thoughts and the inability to process information.

Mental illnesses are characterized by behavioral patterns which may interfere with one's daily work and social functions. Some people with mental illnesses need no support, while others need occasional support or substantial, ongoing support.

Symptoms and Behaviors

The course of mental illness is irregular and unique to each individual. While a single symptom rarely is a sign of mental illness, a symptom that occurs frequently, lasts several weeks, or becomes part of a person's pattern of behavior may indicate mental illness.

Symptoms include:

Personality change over time
Confused thinking, strange ideas
Feelings of extreme highs or lows
Anxieties, fears, anger, suspicion
Social withdrawal, decreased friendliness
Denial of problems and refusal of help.

Employers may notice the following changes in employees' work habits or performance:

Consistent tardiness or absences
Low morale
Lack of cooperation or inability to work with co-workers
Reduced interest in one's and decreased productivity
Problems concentrating, making decisions or remembering
Excuses for missed deadlines or poor work

Some Dos and Don'ts

Most mental illnesses, however, are not apparent, and employers' knowledge of an applicant's or employee's mental illness comes from communicating with the individual. ADA prohibits employers from asking such questions such as:

What conditions have you been treated for?
Have you ever been hospitalized?
Are your taking any medication?

Employers can ask the following:

Will you be able to get to work on time?
Can you meet this job's attendance requirements?
Can you meet deadlines under high pressure?

To determine whether an individual can perform the essential job functions with or without reasonable accommodation, employers should ask about past job experiences. Job performance issues and potential accommodations also should be discussed. Employers should consider the individual's specific abilities and limitations, not just a diagnosis, in determining whether an individual can do the job.

Allowing extra time for applicants to complete the application and take tests will reduce anxiety. Interviewing applicants in an enclosed office or in a quite location will minimize distractions.

Providing clear job descriptions that outline the essential functions of a job and break down the job into its physical requirements, psychological demands, and working conditions, will enable applicants to know what is required in order to request accommodations, if necessary. Interviewers should be trained to focus on these same characteristics, the physical, emotional, and social demands of a job that may be affected by mental illness.

Effects in the Workplace

General functional difficulties may accompany mental illnesses. These might include trouble interacting with co-workers, completing work assignments or a full work day due to lack of concentration caused by restlessness, short attention span, easy distractibility, or the inability to block out sounds, sights, or odors.

In addition, the side effects of medications, which may cause drowsiness, headaches, confusion, dizziness, and nervousness, can interfere with work productivity.

Individuals with mental illness might also have difficulties handling time pressures or multiple tasks, managing assignments, meeting deadlines, prioritizing their work responsibilities.

The irregular and episodic nature of a mental illness may prevent employees from maintaining consistent work patterns. They may need time off for medical appointments or to recuperate from an episode or treatment. For instance, people with depression may have episodes of despair that make it difficult to work; manic depressives may have mood shifts which may affect productivity. Each employee will be affected differently, depending on the symptoms, severity, and duration of that individual's illness.

Providing Reasonable Accommodation

The general cost of accommodating individuals with disabilities is low, less than $500, as determined by the Job Accommodation Network , a free consulting service located in West Virginia. Many accommodations for mental illness cost even less or nothing, simply requiring observation, flexibility, and the application of good management skills.

Determining the appropriate accommodation should include talking with the individual affected and could involve consulting mental health professionals or outside organizations that provide technical assistance to employers.

The following could accommodate functional difficulties encountered by people with mental illness in the workplace:

Changes in the Physical Environment: A work space can be modified to minimize distractions that interfere with concentration. For instance, an employee who has limited concentration or cannot finish assignments on time, might have problems adjusting to work surroundings. Partitions can be added to block out noise and other interruptions, or the employee can be moved to a quiet location or an enclosed office.

Flexible Scheduling: Individualized flexible schedules, which cost little and provide minimal workplace disruption, can be the most useful overall accommodation. These might include allowing employees to take longer or more frequent breaks during the day -- to counteract fatigue and difficulty in concentrating -- or maintaining a liberal leave policy -- allowing employees time off to recuperate from episodes of mental illness. Flexible scheduling should include back-up coverage in cases of prolonged absences.

Job Restructuring: The times at which employees perform particular tasks can be changed to accommodate certain conditions or treatments. Alternatively, problematic nonessential tasks can be reassigned to co-workers, or, employees can be assigned to less-demanding positions. Employers can break down assignments into small tasks or otherwise help employees understand the relationships among tasks. Employers also might create part-time positions or schedules that allow employees to build up their abilities to handle full-time workloads, or create job sharing positions -- splitting one position's responsibilities between two part-time employees.

Improved Communications: Establish work plans and goals for employees and schedule meetings for employees and supervisors to discuss an employee's progress and problems and provide feedback. Provide employees with written, clear explanations of job duties, assignments, and due dates to help employees manage workflow, deadlines, and to complete tasks.

Additional Supports: Allow job coaches or co-workers to provide on the job help and support. Provide health insurance that covers mental illness and employee assistance programs that provide mental health services and counseling to employees. It is cost-efficient to offer employees low-cost counseling and crisis intervention services as a form of prevention or early intervention. Employers can save money by helping experienced workers recover from temporary problems, rather than paying the costs of long term disability and hiring new employees. (The ADA and People With Mental Illness: A Resource Manual For Employers, The National Mental Health Association and The American Bar Association, 1800 M Street, N.W., Suite 200, Washington, D.C. 20036; (202) 331-2241; ($30)).

More Guidance Needed From EEOC

Many EEOC offices "lack any information on psychiatric disabilities," and employers need more guidance from EEOC on job discrimination based on psychiatric disorders, a congressional report finds.

The 136-page report, Psychiatric Disabilities, Employment, and The Americans With Disabilities Act , was prepared by the Office of Technology Assessment for Senate Labor and Human Resources Committee Chairman Edward Kennedy (D-Mass) and other legislators.

Topics identified in the report as needing more guidance are disclosure of psychiatric disabilities, identifying behavioral and social job requirements, accommodating difficult or threatening behavior, and psychotropic medication and other treatments. (Copies available from the Government Printing Office, P.O. Box 37194, Pittsburgh, Pa. 15250-7954; stock number 052-003-01366-5; $8.50).