The Cornell Just-in-Time Toolkit for Managers

Tips, checklists, and resources to help managers lead a disability inclusive workforce.

Topic #9
An Employee Might Have a Psychiatric Disability or Addiction:
Thinking It Through

Many individuals with disabilities encounter misperceptions about their skills and talents due to their disabilities.  There are some disabilities, however, where negative messaging about disability is particularly common.  This includes both psychiatric disabilities and addiction. The stigma around these disabilities is due in part to messages from the media.  Let’s try to clear up some of these misperceptions here. 

We can start by talking about terms.  What’s the difference between “mental illness” and “psychiatric disability”?  These terms are often used interchangeably.  Strictly speaking, mental illness refers to a broad range of conditions, such as depression, anxiety disorder, or bipolar disorder.  Psychiatric disability is used when a mental illness significantly impacts major life activities, like working, communicating or learning.  We use the term psychiatric disability here because this would refer to conditions that are usually considered disabilities under the ADA (Boston University, Center for Psychiatric Disability and Mental Illness, 2015.

Fact from fiction

Psychiatric disability is one of the largest categories of disabilities covered under the ADA. Currently, nearly 20% of the U.S. population has a diagnosed psychiatric disability (NIMH, 2014). A report by the World Health Organization found that psychiatric disability is also the largest single category of disability in the developed world, surpassing cancer and heart disease (U.S. CDC, 2014). Nearly 50% of the current U.S. population will develop a psychiatric disability at least once during their lifetime (U.S. CDC, 2014). Despite its prevalence, psychiatric disability continues to be an impairment shrouded in shame and misperception.  

Myth: Individuals with psychiatric disabilities are very likely to be violent at work.

Fact: The vast majority of individuals with psychiatric disabilities do not pose a danger to others at work (Monahan, 1992; Monahan, et. al., 2005; Peterson, et. al., 2014).

Myth: Few individuals with a psychiatric disability recover.

Fact: The vast majority of individuals with a psychiatric disability successfully manage their conditions and lead fully productive lives.

Myth: A psychiatric disability is the result of weakness, a character flaw or poor parenting.

Fact: A psychiatric disability stems from differences in brain function.

Myth: The Americans with Disabilities Act (ADA) does not consider a psychiatric disability to be a disability.

Fact: The ADA defines disability as “a mental or physical impairment that substantially limits one or more major life activities” and can include psychiatric disabilities. 

Myth: Individuals who have been diagnosed with a psychiatric disability cannot tolerate stress or negative performance feedback at work.

Fact: Individuals with psychiatric disabilities can be held to the same performance standards applied to any other employee.

Myth: Job applicants who have a history of a psychiatric disability must disclose this to a potential employer.

Fact: The ADA guarantees the right of job applicants with a psychiatric disability to choose whether or not they will disclose this to a potential employer.

Myth: The ADA does not allow employers to conduct drug screens of applicants or employees because individuals with addictive disorders are covered under the ADA.

Fact: Applicants or employees actively using illegal drugs are not protected under the ADA. 

Do employees with a history of psychiatric disability pose danger to others? 

Research does not support the belief that individuals who have been diagnosed with a psychiatric disability pose a threat to others (Monahan, 1992; Monahan, et. al., 2005; Peterson, et. al., 2014). If a manager happens to find out that an employee has a history of a psychiatric disability, this history alone would not mean there is a direct threat or dangerous situation. But if a manager has a reasonable belief based on concrete evidence that an employee’s behavior poses danger to others, the manager can act to mitigate that danger. What is concrete evidence? For example, a manager who over-heard an employee making violent threats to harm others would be acting on a reasonable belief that this employee poses a direct threat and could take appropriate action, including termination. This would be the case whether or not the employee had a history of a psychiatric disability.

When a manager suspects that a psychiatric disability impacts performance 

Any employee who engages in misconduct or has poor performance is subject to the codes and policies that are uniformly applied in the workplace. This is the case whether or not the manager suspects the poor performance is caused by a psychiatric disability or an addiction problem. This employee’s performance or conduct issue should be handled like that of any other employee. Have a private conversation with this employee where the events that illustrate the performance problem are clearly and objectively described. If the employee tells the manager that a psychiatric disability (such as depression or bipolar disorder) impacts their performance on the job, the manager should treat this as an accommodation request. The manager does not need to rescind any warnings or actions taken prior to this disclosure and accommodation request.

About addiction

Addiction is a condition that causes a person to continue to use of a substance (i.e. drugs or alcohol) or engage in an activity (i.e. gambling, sex, or shopping) even after it interferes with their daily life.  Casual use of substances or activities are not addiction.  Addiction becomes a disability when the person with an addiction or history of addiction experiences substantial limitation in one or more major life activities.  

Current vs past addiction to substances

Employers can have substance-free workplace policies and discipline employees who do not comply.  However, these policies must apply to current use of substances.  Employees who have a history of prior drug use or addiction (for which they are now in recovery) cannot be discriminated against or terminated because of this prior use.

When a manager suspects that an addiction impacts performance 

Employees who are addicted can be held to the same performance standards applied to any other employee. They may be reprimanded or terminated when they violate these standards, whether or not the violation was due to addiction issues. But an employee with addiction issues whose conduct does not warrant termination can request an accommodation such as temporary leave or a modified schedule to attend treatment sessions. 

Get support

All employees with addiction issues or psychiatric disability can be referred to Cornell’s Faculty Staff assistance program for a range of confidential support services for employees experiencing personal problems.  This is the case for employees who are dealing with these issues in their families.  To contact, call 607.255.COPE or visit http://fsap.cornell.edu

What can a manager ask?    

As a rule, do not ask employees about their mental health.  Here are some basic “do’s” and “don’ts.” 

  • DO contact your local HR Manager and Medical Leaves Administration at 607.255.1177 or visit Disability Accommodations if you have any questions about a disability-related issue.
  • DO make all employees aware of their legal right to an accommodation for mental or physical disabilities covered under the ADA.
  • DO privately discuss performance issues as soon as they arise, without speculating about the cause of those issues.
  • DON’T ask an employee if a psychiatric disability or addiction is the cause of a performance or conduct problem. However, if the employee has previously disclosed that they have a psychiatric disability or addiction issue and the manager has a reasonable belief that this impacts their performance or poses a direct threat to others, the situation changes. In this case, the employer may privately ask the employee about their mental health status and can require medical documentation to determine next steps. Contact your local HR Manager or Cornell’s Medical Leaves Administration office for assistance in this situation as managers should not collect medical documentation from employees. 
  • DON’T talk to other employees about your belief that a psychiatric disability or addiction issues might be the cause of a performance problem.
  • DON’T ask about or try to monitor an employee’s medication, even if you believe that the employee has gone off their medication.

Thinking through accommodations

Many managers struggle with understanding workplace accommodations for employees with psychiatric disabilities and addiction. Yet, given the sheer numbers of individuals with these disabilities in the workplace, being able to accommodate these employees is not just a “nice to do.” It is key to preventing turnover, reducing off-work time, and enhancing productivity for this large number of employees. Here are some examples of accommodations for employees with psychiatric disabilities:

  • A salesperson with bipolar disorder uses the company’s EAP service in conjunction with his regular treatment to deal with issues around his disability in the workplace.
  • A records clerk with anxiety disorder is moved to work in a more quiet and private space.
  • A bio-medical researcher with depression works at home three days a week.
  • A nurse with ADD is given more reminders and “check points” to make sure he is effective in recording patient medications.
  • An accountant with depression is allowed to take two hours off in the middle of the day to attend treatment, making up for this time during weekends.

People with addiction issues may also seek accommodation.  Here are some examples.

  • A recovering alcoholic seeks extra time at lunch to attend meetings and offers to make up the time by staying later in the evening.
  • A recovering gambling addict uses the company’s EAP to address triggers for their addiction in the workplace.
  • An employee recovering from substance abuse seeks a one-month leave to attend treatment to prevent a relapse.  

References

Boston University, Center for Psychiatric Rehabilitation (2015).  What is psychiatric disability and mental illness?  Accessed at http://cpr.bu.edu/resources/reasonable-accommodations/what-is-psychiatric-disability-and-mental-illness.

Monahan, John. (1992) “Mental Disorder and Violent Behavior: Perceptions and Evidence.
American Psychologist, April, Volume 47, Number 4, p. 519.

Monahan, J, Steadman, H., Robbins, P., Appelbaum, P., Banks, S., Grisso, T., Heilbrun, K., Mulvey, E., Roth, L., and Silver, E. (2005). An actuarial model of violence risk assessment for persons with mental disorders. Psychiatric Services, 56, 810-815.

National Institute of Mental Health. (2014). Health, Education & Statistics:  Prevalence of Any Mental Illness Among Adults.  Accessed at http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml.

Peterson, J., Kennealy, P., Skeem, J., Bray, B., & Zyonkovic, A. (2014).  How often and how consistently do symptoms directly precede criminal behavior among offenders with mental illness?  Law and Human Behavior, online April 15, 2014.  DOI: 10.1037/lhb0000075

Steadman, H., Mulvey, E., Monahan, J., Clark-Robbins, P., Appelbaum, P., Grisso, T., Roth, T., and Silver, E. (1998) Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods. Archives of General Psychiatry. Vol 55 No. 5, pp. 389 – 477, May 1998.

U.S. Centers for Disease Control. (2014). CDC Statistics:  Mental Illness in the U.S. Accessed at http://psychcentral.com/blog/archives/2011/09/03/cdc-statistics-mental-i...

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. Text Revised).  Washington, DC