Disclosure of mental illness to prospective employers: Clinical, psychosocial, and work correlates in persons receiving supported employment

Disclosure dilemmas: how people with a mental health condition perceive and manage disclosure at work

PURPOSE

Little research has explored the process of disclosure decision-making from antecedents to outcomes. This paper presents a model of decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace shortly after starting a new job.

METHODS

A qualitative descriptive design was employed to explore participants' experiences of the disclosure decision-making process, the disclosure event itself (if applicable), and their perceptions of the impact of the decision on personal, interpersonal, and organizational outcomes. The transcripts were coded and analyzed using directed content analysis.

RESULTS

Twenty-eight participants were purposively selected to represent different disclosure decisions, sex, diagnoses, and maintenance of employment. Analysis identified goals and conditions/context were important antecedents for the disclosure decision. All participants discussed concerns about prejudice and discrimination if they disclosed, and, for those who chose to disclose, high stress and anxiety were described during the disclosure event; however, supervisor reactions were generally described as positive.

CONCLUSIONS

Regardless of the disclosure strategy adopted, participants reported that their disclosure decision helped to support their self-acceptance and recovery. For those who disclosed, most perceived a positive response by their supervisor. However, the pervasive concerns of prejudice indicate there is still much work to be done.IMPLICATIONS FOR REHABILITATIONDecision-making about disclosure of a mental health condition to the immediate supervisor in the workplace is a complex process.Disclosure goals, the relationship with the supervisor and the workplace context are important antecedents to the disclosure decision.Careful consideration should be given to the planning of disclosure, particularly related to what information will be shared, how it will be shared, and an appropriate level of emotional content to enhance the likelihood of a positive response from the supervisor.Disclosure planning should take the supervisor's style and organizational norms into account.

Employment Outcomes After Certification as a Behavioral Health Peer Specialist in Four U.S. States

OBJECTIVE

A 3-year study explores employment outcomes of certified peer specialists (CPSs). Analyses reported here identified relationships between demographic, clinical, work history, and geographic characteristics and employment status and current employment in peer services jobs versus other jobs.

METHODS

The study recruited adults who recently became a CPS, regardless of current employment status, in four states. Online survey data were collected from March to October 2020 and included demographic information, health status and diagnoses, mental health service use, motivations for becoming certified, employment history, and job characteristics, including job satisfaction. Descriptive statistics and logistic regression models were used to compare groups.

RESULTS

Of 681 respondents, 591 provided data on current employment and were included. Participants who received Social Security Disability Insurance or Supplemental Security Income, veterans, those who used outpatient counseling or therapy, and those who did not disclose their mental health status in the workplace were less likely to report current employment. Lack of disclosure and higher local unemployment rates contributed to a lower likelihood of working in peer services jobs, whereas individuals reporting depressive disorders were more likely to hold such jobs. Compared with those in other jobs, those in peer services jobs reported longer job tenure, and a larger proportion received employee benefits. Job satisfaction was significantly higher among those with peer services jobs.

CONCLUSIONS

Workers with a CPS credential had higher employment rates, compared with adults with psychiatric disabilities, and the quality of peer specialist jobs was equal to or higher than the quality of other jobs held by study participants.

An examination of the psychosocial factors impacting workplace accommodation requests in individuals with mental disabilities

BACKGROUND: Individuals with mental health issues experience profound stigma and discrimination, which may contribute to a lack of accommodation utilization to address functional limitations of their work. OBJECTIVES: This study examined how psychosocial factors may predict the request of accommodations by employed individuals with mental disabilities through the framework of social cognitive career theory. METHODS: In the United States, 148 employed adults with mental disabilities completed an online questionnaire to ascertain self-efficacy, outcome expectation, affect, and workplace support. Logistic regression analyses were conducted to examine associations between respondents’ psychosocial factors and request of accommodations. RESULTS: Psychosocial factors (i.e., self-efficacy in accommodation request, outcome expectancy in employers’ compliance with accommodation request, and non-person cost associated with request) were associated with impacting decisions to request accommodations among individuals with mental disabilities. CONCLUSIONS: A focus on bolstering self-efficacy and outcome expectation may assist rehabilitation professionals with facilitating positive occupational outcomes for individuals with mental disabilities. Incorporating increased education on the possible implications of mental disabilities in the workplace may also promote successful employment outcomes.

Barriers and facilitators to requesting accommodation among individuals with psychiatric disabilities: A qualitative approach

BACKGROUND: Employees with psychiatric disabilities experience a great amount of workplace challenges such as lacking workplace supports and job accommodations. There is a lack of research surrounding job accommodations for persons with psychiatric disabilities within the United States. Thus, research is warranted to understand how to meet the needs of this population via accommodations. OBJECTIVE: This study examined barriers and facilitators to requesting accommodations among employees with psychiatric disabilities through a qualitative approach. METHODS: This study recruited 120 participants from multiple agencies serving individuals with psychiatric disabilities in the United States. Themes regarding barriers and facilitators were identified using the conventional content analysis approach. RESULTS: The most commonly identified themes were employees’ fear and anxiety negatively impacting accommodation seeking behaviors, employer discrimination and non-inclusive workplace culture, and employers lack knowledge of disabilities and ADA. Participants also identified positive experiences in requesting accommodations. CONCLUSION: Rehabilitation professionals and employers may utilize current findings, facilitate a positive and inclusive workplace environment and assist employees with disabilities to take full advantage of workplace resources and job accommodation to exert their potentials.

Predictive Association of Low- and High-Fidelity Supported Employment Programs with Multiple Outcomes in a Real-World Setting: A Prospective Longitudinal Multi-site Study

PURPOSE

The individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs).

METHODS

A prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups.

RESULTS

There were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p < 0.001), and better match for illness disclosure preference (92.6% versus 68.0%, respectively, aOR = 5.9, p = 0.003). However, we found no differences between groups in other preference matches or PROM outcomes.

CONCLUSION

High-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future.

CLINICAL TRIAL REGISTRATION

UMIN000025648.

Vocational Service Models and Approaches to Improve Job Tenure of People With Severe and Enduring Mental Illness: A Narrative Review

Employment is a valued occupation that offers a sense of meaning, identity, and belonging. For people with severe and enduring mental illness, employment has also been associated with personal recovery and decreased use of mental health services. However, this population continues to be underrepresented in the labor market. Sustainable employment is often challenging for people with severe and enduring mental illness, due to a combination of personal, organizational and systemic issues. While Individual Placement and Support is an evidence-based model of employment support known to improve job attainment for people with mental illness, job retention and sustained workforce participation continue to be challenges. This narrative literature review was undertaken to address the question: "What vocational service models and approaches improve job tenure for this population?" CinAHL, Medline, Embase, PsycINFO, and Cochrane Library were searched for the period 2005-2020, using key terms and subject headings, including "severe mental illness," "psychiatric disabilit^*," "job tenure," and "job retention." Several adjunct interventions may enhance job retention, including skills training, cognitive interventions, psychological interventions, and supported education, while social firms offer a different approach focused on creating new, sustainable job opportunities. Peer support and support from family and friends also appear to be important, and emerging evidence suggests that employment specialist practices, technology, self-management, and workplace accommodations may each also influence job tenure. Service providers could make more use of these non-clinical vocational approaches to improve employment retention for people with severe and enduring mental illness.