“How do we accommodate someone who is claiming to have a disability?” I get this question, in one form or another, on weekly basis. Though two laws—the Americans with Disabilities Act (ADA) and its partner, the ADA Amendments Act (ADAAA)—lay out federal regulations for addressing disabilities in the workplace, these laws are arcane, confusing, and open to diverse interpretations. Many employers struggle to figure out and comply with the ADA and ADAAA, not to mention the myriad other policies triggered by employee disabilities: the Family Medical Leave Act (FMLA), the Uniformed Services Employment and Reemployment Rights Act (USERRA), Occupational Safety and Health Administration (OSHA) rules, and Maryland’s recently-passed Flexible Leave Act—to name a few. Before we can delve into some of the common psychiatric illnesses that show up in the workplace, it’s important to outline the ADA’s scope and what constitutes a disability from a legal standpoint. The ADA was passed in 1990, and went into effect in 1992. Nearly two decades later, following countless disability lawsuits, President Bush signed the ADAAA, which made modifications to the original act. Note that the ADA only applies to businesses with more than fifteen employees, though many local state laws mirror the act’s policies, and do affect businesses with fewer employees. The ADA provides three definitions of a disability:
- A mental or physical impairment that substantially limits one or more major life activities—sometimes referred to in regulations as an “actual disability”
- A record of a physical or mental impairment that substantially limits their major life activities; in other words, a record of a disability
- When an employer takes an action prohibited by the ADA because of an actual or perceived impairment
This series concerns the first definition, people with “actual disabilities,” specifically those diagnosed with mental impairments.
What Is Psychiatric Illness?
In medicine, psychiatric illness has historically been tied to abnormal behavior. Mental health practitioners such as Dr. Heitt recognize behavior as abnormal if it statistically deviates from the societal norm, causes marked distress, and/or impairs a person’s function. Mental disorders are the leading cause of disability in the U.S. and Canada, with approximately one-quarter (26%) of adults afflicted with a diagnosable mental disorder in a given year. Nearly half of that group (45%) meet criteria for two or more co-existing disorders (e.g. simultaneous depression and drug abuse, or ADHD and anxiety). If these numbers seem high, consider the difference between a mental disorder and what Heitt calls a “serious mental illness:” though many of us cope with depressive and anxiety disorders in our everyday lives through the use of medication and therapy, only 6% of American adults suffer impairments that leave them incapacitated and unable to operate productively in a social environment. You’re less likely to encounter these individuals in a typical workplace.
Psychiatric Illness in the Workplace
But while mental conditions are common, and many fly under the radar, HR managers should be aware of how these disabilities can manifest in behavior and work performance, as well as what accommodations to make for them.
Each year, around 10% of adults experience mood disorders such as depression (also known as major depressive disorder) and bipolar disorder (formerly called manic-depressive disorder). These individuals may display excessively high or low energy, or dramatic changes in mood from one period to the next. Mood disorders can result in decreased productivity or, conversely, the individual biting off more than they can chew and failing to deliver on overly-ambitious goals. Both external and internal factors can cause depression. Some individuals become depressed after a traumatic event, such as the loss of a loved one; while others suffer chronic, endogenous depression that follows them throughout their lives. Left untreated, depression may lead to suicidal thoughts and tendencies. Employees affected by bipolar disorder, on the other hand, display a wide range of emotions and behaviors—some of which others perceive as positive traits. In a manic state, these individuals seem enthusiastic, tireless, and brimming with initiative. They’re hyperactive and hyperverbal, taking on multiple projects, and offering an endless stream of ideas. Manic behavior, however, can quickly turn sour when it does harm to other employees or evaporates without warning into a depressive personality, or when lack of follow-through produces poor results.
Anxiety is by far the most prevalent mental disorder in the workplace, affecting approximately 18% of employees. Those with anxiety may experience generalized anxiety disorder (or free-floating anxiety), obsessive-compulsive disorders, phobias such as fear of crowded spaces or fear of social interaction, and post-traumatic stress disorder. These conditions vary in intensity, but even simple phobias—like a fear of flying—can impair important work activities, such as business travel. PTSD in particular is a growing concern for HR managers, as more veterans diagnosed with the disorder return from combat and reintegrate into the workforce. Not all sufferers of PTSD have direct experience with a life-threatening situation, however: some develop the condition after witnessing a life-threatening event, even one for which they weren’t physically present. Employees with PTSD often avoid stimuli related to their trauma, and may appear irritable, on-edge, paranoid, or hyper-vigilant.
Substance Abuse Disorders
Substance abuse can severely interfere with an employee’s ability, but may go undetected for long stretches of time. Alcohol, illegal drugs, and prescription medication addictions can lead to erratic behavior, workplace accidents, and sloppy work. Smells of alcohol or smoke on or around an employee are strong indicators of abuse, and are worth investigating. In extreme cases, abuse becomes life-threatening. Someone who is currently using drugs or alcohol is not protected under the ADA. Even if a drug or alcohol abuser is diagnosed with alcoholism or another type of addiction, no legal accommodations must be made as long as the employee continues to report to work under the influence. On the other hand, the ADA does consider recovered alcoholics and drug users disabled, provided they have a history. If you suspect an employee is under the influence of drugs or alcohol, refer to your employee policy on the matter and follow it carefully. Some workplaces adhere to policies that allow managers to terminate employees based on suspicion of drug or alcohol use, while others mandate breathalyzer or drug tests prior to termination. If an employee has been involved in a workplace accident—especially a dangerous one—it is never a bad idea to institute a drug test.
Psychotic disorders are rare, especially in workplaces, due to how severely they impair mental function, but they are alarming nonetheless. Examples include schizophrenia, delusional disorders, seizures, and delirium-causing illnesses such as Alzheimer’s and Parkinson’s disease.
Attention Deficit Disorders
In spite of the widespread belief that attention deficit disorders predominantly affect children, a great deal of those with ADD or ADHD carry the condition forward into adult life. Though some adapt to and learn to accommodate their disorder’s effects at an early age, others continue to suffer throughout their careers.
Autism is a controversial topic, and many workplaces are only just beginning to learn about and meet the needs of employees who fall on the autism spectrum. Autism disorders vary in perceived intensity. Some people may show clear symptoms, such as the inability to speak, while others display less pronounced characteristics e.g. inflexibility, interpersonal conflict, perfectionism, and intense interests. People with Asperger syndrome, a common autism spectrum condition, are characterized by their difficulty engaging in ordinary social interaction and their atypical use of language. These are only a few examples of the kinds of psychiatric illnesses one may encounter in the workplace. So what can managers do to best meet the needs of employees suffering these conditions and avoid discrimination charges? In my next installment in this series, I’ll discuss best practices for accommodating mental illnesses, handling documentation, and the role of a consulting psychologist.
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