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Accommodation and Compliance Series:
Employees with Mental Health Impairments

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Introduction

JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee’s individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar.

Information about Mental Health Impairments

How prevalent are mental health impairments?

Approximately 58 million Americans, one in four adults, experience a mental health impairment in a given year (National Alliance on Mental Illness, 2007). One in seventeen individuals lives with a serious mental health impairment, such as schizophrenia, major depression, or bipolar disorder (National Institute of Mental Health, 2008) and about one in ten children have a serious mental or emotional disorder (U.S. Department of Health and Human Services, 1999).

What are mental health impairments?

The DSM-IV (the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (APA), provides diagnostic criteria for mental health impairments. According to the DSM-IV (APA, 1994), a mental health impairment is:

a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one.

The National Alliance on Mental Illness (NAMI) (n.d.a) defines a mental health impairment as:

a medical condition that disrupt a person's thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

What are some common mental health impairments?

JAN receives numerous accommodation questions related to individuals with mental health impairments working successfully. Although there are various definitions and lists of impairments, this document covers those that are received the most by JAN. NAMI provides useful definitions of mental health impairments and statistics on their prevalence. The following (NAMI, n.d.b) is a summary of these:

Mental Health Impairments and the Americans with Disabilities Act

Are mental health impairments considered disabilities under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with mental health impairments will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For additional information on the definition of disability, go to JAN's Accommodation and Compliance Series: The ADA Amendments Act of 2008 of 2008 at http://AskJAN.org/bulletins/adaaa1.htm.

Where can employers get additional information about mental health impairments and the ADA?

JAN provides resources on mental health impairments and the ADA at http://AskJAN.org/media/psyc.htm. This includes accommodation ideas, information on the ADA and its amendments, and guidance from the EEOC. Two EEOC guidances that may be helpful working through the accommodation process are: The ADA and Psychiatric Disabilities at http://www.eeoc.gov/policy/docs/psych.html and The ADA: Applying Performance and Conduct Standards to Employees with Disabilities at http://www.eeoc.gov/facts/performance-conduct.html.

Accommodating Employees with Mental Health Impairments

Note: People with mental health impairments may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with mental health impairments will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.

Questions to Consider:

  1. What limitations is the employee with a mental health impairment experiencing?
  2. How do these limitations affect the employee and the employee’s job performance?
  3. What specific job tasks are problematic as a result of these limitations?
  4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
  5. Has the employee with a mental health impairment been consulted regarding possible accommodations?
  6. Once accommodations are in place, would it be useful to meet with the employee with a mental health impairment to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
  7. Do supervisory personnel and employees need training regarding mental health impairments?

Accommodation Ideas:

Attendance:

Concentration:

Emotions:

Fatigue:

Memory:

Organization:

Panic Attacks:

Sleep Disturbances:

Stress:

Coworker Interaction:

Working Effectively:

Two common issues that JAN receives inquiries on are: (1) what accommodations will work for individuals with mental health impairments when workplaces are implementing substantial changes, and (2) what accommodations will help supervisors work effectively with individuals with mental health impairments. Many accommodation ideas are born from effective management techniques. When organizations are implementing workplace changes, it is important that key personnel recognize that a change in the environment or in supervisors may be difficult. Maintaining open channels of communication to ensure any transitions are smooth, and providing short weekly or monthly meetings with employees to discuss workplace issues can be helpful.

Supervisors can also implement management techniques that support an inclusive workplace culture while simultaneously providing accommodations. Successful techniques include the following:

Situations and Solutions

A secretary with post-traumatic stress disorder (PTSD), who had been carjacked several years earlier, experienced significant anxiety during commutes after dark. This caused difficulty concentrating and irritability. She was accommodated with the ability to have a support animal at work and a flexible schedule with work from home during periods of minimal sunlight.

A graphic designer with a panic disorder experienced recurrent panic attacks when traveling during peak traffic times. He was required to drop off design orders and pick up print proofs from a print shop when necessary. He was accommodated with a schedule that gave him the opportunity to drop off and pick up materials when coming to work in the morning.

A baker with OCD repeatedly checked ingredients for recipes. The individual was accommodated with a computerized checklist for each baked good recipe on the menu. He was allowed time in the morning to arrange and check off items to be used during the day. When he felt the urge to recheck the ingredients he could do this quickly by using his daily checklist. This checklist was placed in a handheld computer that resembled the two-way radios used by all employees.

A grocery store bagger with SAD had difficulty working an early schedule due to oversleeping. She also experienced fatigue and depression during late fall and winter months. She was accommodated with an afternoon schedule and was moved to the front of the store, which had windows that let sunlight enter her workspace.

An accountant for a large agency had bipolar disorder. His duties included research, writing, and filing reports. He had difficulties with concentration and short-term memory during very busy periods that required long hours. He was accommodated with a more consistent caseload that did not result in extreme fluctuations in workload. He was provided a work area that was away from noise and given earbuds to listen to music. He also met briefly with his supervisor once a week to discuss workload issues.

An electrician with severe depression needed to attend periodic licensure trainings. The person had difficulty taking effective notes and paying attention in the meetings. The individual was accommodated with notes from remote Communication Access Realtime Translation (CART) service.

A veteran with PTSD was working for state government on a team project. The employer decided to move the team’s office to the basement of a building. Once the move occurred, the veteran realized that the noises in the basement were triggering memories of explosions and causing flare ups of his PTSD. The employer did not want to move the entire team again but was able to find an office on the first floor of the same building for the veteran. The rest of the team remained in the basement, but team meetings were held upstairs.

Products:

There are numerous products that can be used to accommodate people with mental health impairments. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved December 1, 2011, from http://AskJAN.org/links/ADAtam1.html

National Alliance on Mental Illness. (2007). Mental illness: Facts and numbers. Retrieved December 1, 2011, from http://www.nami.org/Template.cfm?Section=About_Mental_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=53155

National Alliance on Mental Illness. (n.d.a). What is mental illness: Mental illness facts. Retrieved December 1, 2011, from http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Mental_Illness.htm

National Alliance on Mental Illness. (n.d.b). Mental illness: By illness. Retrieved December 1, 2011, from http://www.nami.org/Template.cfm?Section=By_Illness

National Institute of Mental Health. (2008). NIMH: The numbers count— Mental disorders in America. Retrieved December 1, 2011, from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml

U.S. Department of Health and Human Services. Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services,1999, pp. 408‐409, 411.

Updated 03/07/13

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