Mental Illness on the Job: Conceal It or Reveal It?



Years ago I worked as a reporter on a small town newspaper, and one day at the water cooler a colleague suggested taking a mental health day.

“A mental health day?” the editor called out from his office in a sarcastic tone of voice. “What’s that?”

I vowed then never to say a word about my insomnia to my boss, or about any of my daytime symptoms, including physical exhaustion and trouble thinking. In the hard-charging environment of a newsroom, wouldn’t they be seen as liabilities?

My suspicions were confirmed a couple years later. My boss at a larger newspaper happened to ask how I was doing after one of my sleepless nights, and unthinkingly I blurted out that I was exhausted.

“Exhausted?” he repeated with a frown. “I don’t want reporters who are exhausted. I want you ready to kick butt!”

The rebuke was unsurprising but it stung. Never again did I divulge any personal information that could reflect negatively on me in the eyes of an employer.

So when a fellow NAMI volunteer recently sent me information about disclosure of mental illness in the workplace, I was curious enough to look further. What might experts have to say about whether and how to talk about a mental health condition with an employer? Here is information from academic researchers and mental health organizations on the internet, sources that can be accessed by clicking the links.

A Complex Decision With No Easy Answers

Everyone seems to agree: there is no right or wrong answer to the dilemma of whether to disclose your mental health status at work. Nor is the path to a decision usually simple.

In employment situations, “mental health disclosure involves a complex decision-making process,” say Emily Hielscher and Geoffrey Waghorn in an article published in 2015 in “Psychiatric Rehabilitation Journal.”* Decisions turn on many factors and may have to be re-evaluated over time as circumstances change.

Disclosure and Nondisclosure: Advantages and Drawbacks

A work situation where you can share information about your mental health status with your boss is an undeniable boon. Disclosing a psychiatric disability entitles you to reasonable accommodations that can help you increase and/or sustain your job performance, such as these:

  • a flexible work schedule or start time
  • reduced distractions or noise at work
  • access to a private, quiet space during breaks
  • the option to work from home
  • regular feedback, written or verbal

Other advantages include relief from the stress of having to hide personal information. Freedom from having to dissemble and accommodations that assist you at work may actually improve your mental health.

The drawbacks to disclosure, largely attributable to stigma and stereotypes, are all too familiar. With a mental health diagnosis, you may be seen as a less competitive job candidate, experience increased scrutiny on the job, or be passed over for assignments or overlooked for promotion. (In cases of suspected discrimination, you may be able to look for remediation to two federal laws described in the next section.)

There are pluses and minuses to nondisclosure, too, the main advantage being avoidance of the stigma connected with mental illness and the consequences. But people who choose this path — whether because of the perceived manageability of their illness, the position they occupy or the simple inadmissibility of any personal information in the workplace — may end up having to fabricate excuses for behaviors and symptoms related to their condition and time off work if the going gets rough.

Legal Protection From Discrimination

As you weigh whether to tell your boss about your mental health condition, it helps to be familiar with the laws that protect people from discrimination due to mental illness. There are two federal laws, and both are described in more detail on the NAMI National website:

  1. The Americans with Disabilities Act (ADA) of 1990 prohibits discrimination against job applicants and employees with disabilities. The law applies to state and local government employers and to private employers with over 15 employees. To qualify for protection, you must be able to show that you (a) have a disability that substantially impairs one or more major life activities, and (b) are able to perform the essential functions of your job “with or without reasonable accommodations.”
  2. The Rehabilitation Act of 1973 (Rehab Act) applies to any agency or group that receives federal funding, including public schools, universities, and some private schools. Workers at any of these government-funded entities are protected from disability discrimination.

In addition, the Family Medical Leave Act (FMLA) of 1993 is a federal law that allows employees to take up to 12 weeks of unpaid leave in the event of an illness, affording protection to people who might experience psychiatric crises. FMLA is applicable if you’ve worked at least 12 months for an employer with over 50 employees.

Outcome of Disclosure

For help in deciding whether to discuss your mental health status with an employer, it’s logical to look at how disclosure typically affects employment outcomes. But here the evidence is mixed.

Some studies have found that disclosure leads to applicants not being offered jobs or having employment terminated prematurely. Other studies have found that disclosure is linked to increased employment duration and that accommodations obtained as the result of disclosure probably play a role. Still others have found no relationship between disclosure and employment outcomes. The mixed evidence offers no clear guidance about whether, when or how to discuss a psychiatric disability with an employer.

“It seems that disclosing could be both beneficial and detrimental at different times within the same job, and across different jobs,” Hielscher and Waghorn write.

What Feels Right to You

Researchers are developing tools** to help people discover what feels like the best course to them. Whatever your decision, it has to feel right to you.

Thus it’s important to factor your personal characteristics into the mix: the severity of your diagnosis, for example, your previous experience with stigma, your confidence in your ability to meet challenges, your capacity to regulate your work situation, and the importance of having a particular job.

Nature of the Job

External factors are the other set of factors to reckon with. Your position, or the one you’re aiming for, may tip the scales one way or the other.

In situations where disclosure might jeopardize your job — work demanding a security clearance, for example, or work that is highly specialized and competitive — it’s common to opt for privacy. In contrast, lived experience of mental illness may be viewed as positive and even required for some job applicants working in the field of mental health, making disclosure of your mental health status obligatory.

Your Employer and Workplace Culture

Personal characteristics of your boss and the overall atmosphere in the workplace may require careful consideration on your part. This is hard to manage from afar, a situation you typically face if you’re looking for work. However, Boston University’s Center for Psychiatric Rehabilitation encourages job applicants in recovery to research potential employers’ attitudes toward mental illness before going in for an interview. You may be able to discern these attitudes by looking online for information about companies, organizations and their policies (e.g., whether they offer mentoring programs, are amenable to flex time or telecommuting and have flexible benefit plans). Company newsletters may offer helpful information. You might also get a sense of the company culture by visiting the premises (if it’s allowed) and looking for posted notices about mental health and other employee education programs.

If you’re employed and want to share your mental health status with your boss and ask for accommodations, keep your eyes open for other employees working with accommodations and your ears open for talk about mental health. See if the boss seems open and amenable to employee requests. Listen for information about whether he or she has hired someone with a psychiatric disability before and what the experience was like.

Plan the Disclosure

A small amount of evidence suggests that a planned disclosure strategy can enhance early employment outcomes compared with not planning for disclosure. Planning entails deciding when, how much and how to disclose information about your mental health condition. Here are some considerations.

At the Interview, or Once You’re Established?

If you foresee needing accommodations from the start, consider sharing information about your mental health status with your employer during the interview. You may also want to bring your mental health status up in an interview to gauge the employer’s attitude (and in turn whether the place of employment is likely to be right for you). For more information on asking for accommodations in the workplace and protection under the ADA, visit NAMI’s “Succeeding at Work” and scroll down the page.

Another strategy is to wait to make the disclosure until after you’ve had time to establish relationships with your employer and colleagues but not to wait till a point when you’re having serious problems on the job.

“It is unlikely that you would be protected under the ADA if you disclosed right before you were about to get fired,” according to the Boston University guidelines on disclosing a disability to employers. “Employers are most likely to be responsive to a disclosure if they think it is done in good faith, and not as a last-ditch effort to keep your job.”

How Much to Reveal

The language you use to talk about your mental illness is also a matter of preference. If you’re asking for accommodations that people with disabilities are entitled to under the ADA, the word “disability” will need to be mentioned (as well as what the disability is). Otherwise, online sources agree that it’s up to you to decide on the generality or specificity of the language you use. “A mental health condition” or “bipolar II”? “Trouble with stress” or “generalized anxiety disorder”? Use language that feels comfortable to you.

Script Your Delivery and Lead With Strength

Hielscher, Waghorn and others promote the idea that “the disclosure dilemma should be normalized by reconceptualizing it as a process of ‘managing personal information’” — something we all do to get and keep employment. We all strive to create and maintain a favorable profile as employees or prospective employees by highlighting our strengths and downplaying less desirable characteristics.

To that end, researchers and Boston University’s Center for Psychiatric Rehabilitation suggest it’s advisable as part of a disclosure plan to create a script, which can be practiced in role play in advance of an actual conversation. Further, Hielscher and Waghorn suggest that the script begin with strength-based information, such as why you’re a good fit for the job or your accomplishments at work, and then move into discussion of the mental health condition and requests for supports.

In the United States you’re not required to divulge personal information that might, in the eyes of an employer, make you less attractive as a worker or job candidate. Should you opt to share information about your mental illness with your boss — for whatever reasons — Hielscher and Waghorn maintain it’s to your advantage to do so “in a strength-based way that also conveys useful information to employers and does not trigger unfair discrimination.”

In Closing

At the end of the day, though, the outcome of disclosure is never certain. And for all the protection the ADA affords, discrimination is in reality hard to prove. However, careful consideration of all the factors involved in disclosure of a mental illness to an employer may help you reach decisions that feel comfortable and lead to increased comfort on the job.

*The full text of this article is available at no cost through the library system at the University of Michigan.

**CORAL (COnceal or ReveAL) is a self-help tool under development by a team of British investigators. Its purpose is to support decision-making about mental health disclosure in the workplace. Another tool (MPI, or Managing Personal Information) is being developed in Australia for use by job seekers in collaboration with an employment specialist.

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