Workplaces

Workplaces Quit Quietly Ignoring Mental Illness

By Stephanie Armour, USA TODAY 8/22/2006
http://www.usatoday.com/money/workplace/2006-08-21-depressed-usat_x.htm

At first, it seemed as if little things were going wrong. Bonnie Harris forgot about sales appointments; she couldn't recall colleagues' names. But as her job in sales became more stressful, Harris developed intense mood swings and moments of terror. She saw psychiatrists, who prescribed various medications, but the drugs only made things worse, she says. At one point, she tried to throw herself out of a window.

It wasn't until Harris, an earlier victim of violent crime, was diagnosed with post-traumatic stress disorder (PTSD) that she began to recover with the help of therapy and meditation. But through her entire 1991 episode, she kept working, trying to camouflage what was going on. "I went to work every day. I was a top salesperson, working 60-hour weeks," says Harris, 44. "Co-workers knew I was moody, but no one knew how bad it was. You don't tell people at work that you have this mental illness. It's so shameful."

Today, Harris runs her own firm, Wax Marketing, in St. Paul and knows how to manage PTSD when symptoms creep up. Despite its stigma, a growing number of employers and employees are addressing a topic that has long been taboo: mental illness in the workplace. Employees' emotional health, a topic that once seemed incongruous with the survival-of-the-fittest corporate arena, is getting attention as a real bottom-line issue. Employers are beefing up mental health services as new research shows the staggering cost of mood disorders — depression, anxiety and panic disorder, bipolar disorder, schizophrenia and obsessive-compulsive disorder — can have on businesses.

For example:

• High costs. Untreated mental illness costs the USA $105 billion in lost productivity each year, with U.S. employers footing up to $44 billion of the bill, according to the National Mental Health Association, an Alexandria, Va.-based non-profit.

• Threat of litigation. Federal guidelines issued in 1997 explain how employers can make accommodations for employees with serious mood disorders. Those who don't make accommodations, such as changing an employee's work hours, could be sued. The guidelines are further explanations of the Americans with Disabilities Act, issued by the Equal Employment Opportunity Commission. In fiscal 2004, the EEOC took in $469,000 in financial settlements for employees who complained that they'd been discriminated against because of their depression: 889 cases were filed. By 2005, that amount ballooned to more than $3 million, and there were 1,005 cases filed in that fiscal year.

"There is a greater understanding among employers about these issues," says Chris Kuczynski, assistant legal counsel with the EEOC. Cases filed under the Disabilities Act have become easier to win as the public becomes more aware of mental health issues.

• More emphasis on employer help. A number of employers are enhancing mental health coverage or programs. The number of firms with employee-assistance programs, which often provide on-call counselors and referrals, has climbed from 68% in 2001 to 71% this year, according to the Society for Human Resource Management. Seven in ten offer mental health insurance. Eighteen percent have grief-recovery programs, up from 12% in 2002.

General Motors' program provides U.S. employees with unlimited access to telephone counseling with a trained mental health professional and up to three face-to-face counseling sessions at no charge. GM also helps managers with what to do if an employee has personal issues.

Coverage lags

But companies' mental health coverage often lags behind coverage for physical ailments. Health plans may restrict the number of times an employee can see a mental health provider, for example. Americans battling depression with limited access to mental health care could face bills of $18,000 annually to cover health-related expenses due to their condition, according to the National Alliance on Mental Illness. Those with limited access were four times as likely to quit their jobs.

In recent years, famous business and entertainment leaders have given a public face to mental health issues. 60 Minutes' Mike Wallace and newspaper humorist Art Buchwald shared that they've fought depression. Actress Brooke Shields documented her postpartum depression. Actress Ashley Judd revealed she went to a treatment facility for depression and other emotional problems.

But despite the attention, some employees with mental health issues say they still struggle with how to tell managers what's going on. Sara Kobiela, 26, of Livonia, Mich., has a master's degree in social work but has struggled to keep jobs because of a depression so severe it left her unable to care for herself or do little more than sleep. She has held a variety of jobs, such as file clerk at a medical office and waitress.

At her waitress job, she says her supervisor was very supportive and allowed her to take some time off and return after a depressive episode. But she has just started a new job as an intake counselor at a mental health outpatient center and has so far told only one other person about her struggle. She is on anti-depressants and other medication to help with depressive episodes. She is waiting for insurance to kick in so she can seek out a mental health practitioner.

"You don't want to tell employers, but you need that support at work," says Kobiela, who lives on her own with three cats. "I get very overwhelmed and frustrated at work, but I can put on this front. But I think it's a huge stigma in the workplace."

She says she fears breaking down at work. "When I get depressed, going through the motions of my day, I hate my life, but work is the one thing I can do. You can't be friendly with co-workers (so you worry) they think, 'What's wrong with her, why is she so unfriendly?' ... You don't want to get a label."

'The working wounded'

Like Kobiela, many of those with mental illnesses are younger: Mental illness is highest among those 15 to 44, says Joseph Calabrese, a psychiatry professor at Case Western Reserve University and director of the mood disorders program at the University of Cleveland. Depression ranks at the top. Mental health problems can erode work performance and lead to absenteeism. "These people go to work, but they're the working wounded," Calabrese says.

In many cases, those with mood disorders qualify for employment protections under the federal Americans with Disabilities Act, which means employers must make accommodations to help with work. In order for a mood disorder to be a disability, it must limit a major life activity, such as an employee's ability to sleep or take care of himself or herself. Some types of accommodations have included allowing employees to work from home, modifying supervisory methods, reassigning them or changing a work schedule.

But employers can ask for documentation of mental illness to be sure a disorder is legitimate and they can argue whether that disorder is truly a disability under the ADA. Traits such as irritability or chronic lateness are considered behaviors, not mental impairments requiring accommodations. Employers don't have to make accommodations if doing so would impose an undue hardship, and they cannot retain an employee if that worker poses a direct threat.

Lucinda DuToit, director of human resources at Digineer, a technology consulting firm in Minneapolis, says the shift from ignoring to acknowledging mental illness has come as employers become more aware of the link between personal and professional lives. She also says employers stand to gain valued loyalty from these workers if they make the necessary accommodations.

"There's much more of an understanding of mental illness. In the past, it was just, "We'll see you, bye,' " DuToit says. "Now it's, 'We'll get you help.' " But some employees also have filed lawsuits saying that it's the workplace that caused, or added to, their mental health stress.

The workplace itself

Southwest Airlines employees sometimes pull pranks on co-workers once they've passed their probationary period. But customer-service agent Marcie Fuerschbach says this joke went too far.

At the end of her probation at her job in Albuquerque, co-workers got police officers to handcuff her in a mock arrest. By the time she was in on the joke, she was crying and scared, according to the lawsuit she filed. Later that day, found crying in the bathroom, Fuerschbach was sent home. She says she had to see a psychologist and was treated for post-traumatic stress disorder. She settled her case out of court with police. She lost her case against Southwest.

Southwest spokesman Ed Stewart says, "It was so unfortunate it was taken the way it was, because that was not the intent. Everybody learned from it."

But Fuerschbach, who still has the same job, says she is taking Lexapro, which is used for treating depression and anxiety. "I figured it was real. I thought for sure it wasn't a joke," says Fuerschbach, 48. "It was torture. I was shaking and crying. I was just shocked, handcuffed behind my back. I couldn't work after that."

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Excerpts from "Mental Disabilities in the Workplace" published in Workforce Management
Employers face a host of thorny problems including requests for accommodations due to "stress."

The following is a shortened version of an article by S.P. Sonnenberg (June 2000), "Mental Disabilities in the Workplace," Workforce Management, , Vol. 79, No. 6, pp. 142-146. http://www.workforce.com

One of every two Americans alive today will suffer from a mental illness at some point in their lifetime, according to a recent report by the U.S. Surgeon General. Despite (or perhaps because of) its prevalence, mental illness has been stigmatized and feared.

In addition, the amount of employment litigation related to mental disabilities is steadily increasing. As a result, employers face a host of thorny problems ranging from limits on independent psychiatric evaluations to requests for accommodation of A stress@ and other vague, uncorroborated, or hidden emotional problems. Familiarity with the Americans with Disabilities Act (ADA) and its interpretation by courts and the U.S. Equal Employment Opportunity Commission (EEOC) is essential if an employer is to avoid litigation.

Neither the EEOC nor the ADA itself provides a comprehensive list of all potentially protected mental impairments. Rather, EEOC regulations broadly define a mental impairment as A any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.@ This broad and non-exclusive definition has two implications. First, its open-ended nature, coupled with the subjective and ill-defined nature of emotional illness, virtually ensures that mental health professionals will play a key role in determining -- and disputing -- that an employee suffers from a protected mental impairment. Second, because there is no definitive list of covered mental impairments, employers must analyze disability claims and accommodation requests on a case-by-case basis. The statutory criteria for all impairments, mental or physical, should guide the analysis.

As a general rule, the ADA places mental impairments on an equal footing with physical impairments. Even if an individual is a A qualified individual,@ a mental impairment is not automatically a disability. [For example,] an employer is not required to accommodate mental or physical impairment if doing so would result in an undue hardship.

Litigation of mental disability claims often focuses on whether the employee= s claim meets the statutory criteria: is the employee a A qualified individual@ ?; is the employee substantially limited in a major life activity?; is the requested accommodation a reasonable accommodation?; and/or would accommodation cause the employer an undue hardship?

Tips for Employers

1. If an employee appears or claims to have a mental impairment, scrupulously avoid relying on generalizations or stereotypes regarding mental illness. Analyze situations on a case-by-case basis.

2. A compassionate response to an employee= s workplace problem is always appropriate but resist the temptation to play armchair psychologist.

An employee with attendance infractions or conduct problems will find it easier to claim disability discrimination if a supervisor asks whether the employee= s difficulties are due to A too much stress@ or a A nervous breakdown.@ Instruct managers to document an employee= s performance problem or misconduct by specifically describing the deficiency or behavior at issue.

3. If an employee complains that working with his supervisor is too stressful and causes emotional problems, elicit a written admission that s/he will be able to perform essential job duties only if s/he has a different supervisor or works in a different location.

No matter how debilitating the effects of a mental impairment, it will not be protected under the ADA if it stems solely from an inability to work with a particular supervisor or in a single particular job. Courts and the EEOC agree that an employee is not substantially limited in the major life activity of working unless s/he is significantly restricted in the ability to perform either a class of jobs or broad range of jobs in various classes.

4. Consider even vague requests for accommodation from employees, their family members, or their representatives as triggering a duty to engage in an interactive process with the employee.

Requests for accommodation of emotional problems are often as vague and ill defined as the underlying impairment. A family member may inform a supervisor that the employee is A falling apart@ and needs professional help and A time off@ ; an employee may blurt out in the midst of a rush project that he is so A depressed and stressed out@ that he can A no longer cope emotionally unless something changes.@ Such comments are more than mere complaints; they are, in part, requests for accommodation.

In response to the A requests@ described above, the employer should speak with the employee to clarify the needs and create a written record of the meeting. Assuming that the employee articulates specific requests, the employer need not provide each of the requested accommodations. Rather, it may choose among reasonable accommodations so long as the chosen one is effective.

5. When considering requests for accommodation, remember that the ADA requires employers to accommodate only disabilities that cause substantial limitations, not all disabilities. In other words, a psychiatric diagnosis is not determinative.

In response to an employee= s request for accommodation, an employer= s fact-specific analysis should focus not just on the employee= s psychiatric diagnosis but also on the extent to which the employee is limited, if at all, in a major life activity. The analysis should be based on the employee= s limitation at the time of the requested accommodation.

6. In misconduct situations, distinguish between prospective and retrospective requests for accommodation and ensure that disciplinary rules are uniformly applied.

Courts and the EEOC agree that reasonable accommodation is always prospective, not retrospective. A prospective request for an accommodation that will assist an employee in complying with the company= s conduct rules should generally be granted, so long as it does not cause the employer an undue hardship. However, if an employee is unable (or unwilling) to perform essential functions of her job even with reasonable accommodation, she is not a qualified individual under the ADA. In other words, the ADA typically does not apply, if an employee= s first request for A reasonable accommodation@ is after (retrospective) s/he has been disciplined for poor performance.

7. Don= t be intimidated by psychiatric jargon; mentally impaired employees can often be accommodated in the same ways as physically impaired employees.

8. Designate one person or office to review all company requests for additional medical information about employees; ensure that such requests are narrowly tailored.

9. Require that employees submit to an independent psychiatric examination only in limited circumstances; designate one person or office to review and issue such requests.

To guard against abuse and malingering, an employer may require that a psychiatrist or psychologist of its choice evaluate an employee if one of three conditions is met.

First, a psychiatric examination may be required if an employer has a reasonable belief based on objective evidence that an employee= s ability to perform essential job functions will be impaired by a medical/psychiatric condition.

Second, if an employee requests a reasonable accommodation, and either the mental impairment or need for accommodation is not obvious, an employer may request an independent psychiatric exam.

Third, an employer may require a psychiatric examination if, based on objective, scientific information, the employee poses a direct threat to the health or safety of himself or others because of a medical condition.

10. Treat all information about an employee= s psychiatric impairment as confidential, whether disclosed by the employee, a mental health professional, or a coworker.

11. Review and revise job descriptions to include references to employees= ability to cope with stressful circumstances and to cordially interact with coworkers to accomplish common tasks.

Numerous courts have held that mental stability and the ability to get along with coworkers are essential functions of a job, without which an employee is not qualified. Courts have also held that the inability to cope with a stressful work environment does not constitute a protected disability.

12. Develop relationships with mental health professionals and accommodation experts and maintain a database regarding their work. One way this can help is if an employee threatens a co-worker, supervisor, etc., is often imperative to immediately refer the threatening employee to a psychiatrist with expertise in violence assessment.

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Psychiatric Disabilities, Employment, and ADA: Sample Accommodations for Psychiatric Disabilities

The items on this partial list do not necessarily reflect "reasonable accommodations" as defined by the ADA. The source of this list is from the President's Committee on Employment of People With Disabilities, 1993 compiled by the Ohio Legal Rights cited on website (http://olrs.ohio.gov/ASP/pub_MH_ADATXT.asp) September, 2003.

Flexibility

• Providing self-paced workload and flexible hours &/or supported employment opportunities
• Allowing people to work at home and providing necessary equipment to facilitate this
• Providing job-sharing opportunities &/or exchange of job duties &/or Modifying job responsibilities
• Providing a liberal leave policy (e.g., granting up to 2 months of unpaid leave, if it does not cause undue hardship on the employer) and keeping the job open if take leave of absence
• Providing back-up coverage when the employee needs a special or extended leave
• Providing the ability to move laterally, change jobs, or change supervisors within the same organization so that the person can find a job that is a good fit
• Providing time off for professional counseling &/or Providing conflict resolution mechanisms

Supervision

• Providing written job instructions &/or Easy access to supervisor &/or individualized agreements
• Providing significant levels of structure, one-to-one supervision that deals with content & interpersonal skills
• Providing guidelines for feedback on problem areas and developing strategies to anticipate & deal with problems before they arise
• Arranging for an individual to work under a supportive and understanding supervisor

Emotional Supports

• Providing ongoing on-the-job peer counseling &/or praise and positive reinforcement
• Being tolerant of different behaviors &/or Providing an advocate to advise and support the employee
• Making counseling/employee assistance programs available for all employees

• Allowing telephone calls during work hours to friends or others for needed support
• Providing substance-abuse recovery support groups and one-to-one counseling
• Identifying employees who are willing to help the employee with a psychiatric disability (mentors)
• Providing on-site crisis intervention services &/or 24-hour hot-line for problems

Physical Accommodations at the Workplace

• Modifying work area to minimize distractions &/or Modifying work area for privacy
• Providing smoke-free environment that has reduced noise, natural light, easy access to outside, & is well-ventilated
• Providing accommodations for any additional impairment (e.g., employees with psychiatric disabilities have a visual impairment may need such accommodations as large print for written materials, etc.)

Wages and Benefits

• Providing adequate wages and benefits &/or (specialized) training opportunities
• Providing health insurance that does not exclude pre-existing conditions (i.e., psychiatric disabilities, cancer, etc.)
• Permitting sick leave for emotional well-being, in addition to physical well-being
• Providing assistance with child-care, transportation, care for aging parents, housing, etc.

Dealing With Coworkers' Attitudes

• Providing sensitivity training for coworkers; g Facilitating open discussions with workers with and without disabilities, to articulate feelings and to develop strategies to deal with these issues
• Developing a system of rewards for coworkers without disabilities, based on their acceptance and support for their coworkers with disabilities