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Mental Illness at Work: To Disclose or Not to Disclose

Personal Perspective: After a disastrous experience, I avoid it at all costs.

© cottonbro studio| Pexels
Source: © cottonbro studio| Pexels

The lie started with an interview question I did not expect. “How did you become interested in social work?” The true answer is through my own therapy, but I wasn’t about to say that in an interview. My go-to answer was that the 1983 book August by Judith Rossner, an extremely detailed account of a young woman’s experience in psychoanalysis, inspired me. I said that I became fascinated by the process and wanted to know how the therapist knew what to say and when to say it.

I continued that I then went on to do some further reading on the subject including books by Irvin Yalom and others and that those writings helped convince me to become a social worker. They seemed to accept that. This was my third interview with the company and all the time I was sitting there thinking that one of the first things I’d do if I was considering someone for a position is to Google her. If they did, means they’d know that I have lived experience with mental illness. I had to try to figure out how much they knew and what kind of dance we were acting out.

Fast forward and I’d been with the company about 10 weeks. The need for me to deliberately disclose has not arisen, though I always wonder about what would happen should the need arise every time I start a new job. What triggered these thoughts at that moment was that I was a participant in a supervision group specifically for clinicians who have patients with eating disorders. Sometimes I fantasized about disclosing that I struggled with an eating disorder for many years and offer that unique perspective to the group. At the time, I'd remained silent.

In her 2021 article on disclosing serious mental illness at work, Marjorie Baldwin of Arizona State reports that “workers with mental disorders face a choice when they enter the competitive labor market. Their disability is largely invisible to others, but at some point, they may be confronted with the decision to disclose. Disclosure marks them as a member of a disadvantaged group that is subject to stigma and discrimination in the labor market.”

I struggle with this decision every time I start a new job since a disastrous experience I had four jobs ago, at an outpatient clinic at which I worked from 2007 through 2015.

As Baldwin put it, “Not surprisingly, workers who have experienced mental-illness related stigma in the past are also likely to perceive high costs of disclosure.” Following the death of my father in April 2013 I became depressed. It was not out of grief but rooted in a lifetime of rage and resentment turned inward. My psychiatrist at the time referred me to a partial hospitalization program, so I took about a month off work to attend that. But it didn’t help; instead, things got worse.

In March 2014 I made a suicide attempt and was medically, then psychiatrically hospitalized. While I was in the psychiatric hospital, my boss mailed me a letter firing me, but then verbally reneged. I think she realized this went against the Americans with Disabilities Act. As it turned out, the psychiatrist who was the head of the unit I on which I was admitted did his residency with the psychiatrist who was the medical director of the outpatient clinic. She wanted them to speak to each other which was entirely inappropriate. However, I gave my permission because I was frightened of any possible repercussions.

Another study, on disclosure of mental health status to employers in a healthcare context, states: “It must also be remembered that the personal health of a healthcare professional is often considered private and without the confidentiality offer by the employer or the workplace organization, the healthcare professionals may hesitate to disclose their mental health status.”

When I finally returned to work, it was on a part-time basis — not my choice — and my clinical responsibilities had been curtailed. All the patients on my caseload had been transferred to other clinicians and any administrative responsibilities that involved clinical judgment had been taken away from me. For the first time, I struggled to stretch my work to fill the time I was at my desk. Per the above study, "disclosure unfortunately exposes people to the risk of stigma and discriminatory treatment, and these two factors act as a barrier to finding and maintaining work for mentally ill individuals."

I was able to return to work full-time in September 2014 and resume my clinical admin duties, but I never carried a caseload there again. I did some intakes with new patients, but they were always handed off to other clinicians. I started a new job elsewhere in May 2015.

Since leaving that job, my mental health has been stable, and disclosure hasn’t been a decision I’ve had to make. For which I’ve been grateful. But there are no guarantees. Baldwin stated this obvious but important fact in her article: “Mental illness is not easily observed when its acute symptoms are in remission.” It’s important to remember that the converse is true as well.

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