Individuals with psychiatric
disabilities entering the workforce often contemplate whether to
disclose their disability to employers or coworkers. Because
mental illness is commonly described as a “hidden” disability, the
general public is not likely to notice the disability unless
perceptible psychiatric symptoms or difficulties resulting from the
disability occur. For people with mental illness entering the
workforce and their employment providers, determining the scope and
nature of supports provided by employment specialists at the workplace
may depend on a variety of factors, including the supported employee’s
choices and comfort level with disclosing their disability at
work.
The Americans with Disabilities Act (ADA) (PL 101-336) prohibits
discrimination based on disability, yet individuals with may feel
reservations about the ramifications of disclosing their disability to
workplace personnel due to a fear of vocational stigma, not being
accepted by workplace personnel or being viewed as “different”,
inadequate or incompetent. In a qualitative study, Allen and
Carlson (2003) indicated that individuals chose to conceal their
disability to preserve self-concept and avoid negative
stereotypes. Because of public perceptions about mental illness,
many individuals with psychiatric disabilities express fears of
disclosing the disability to prospective or current employers.
In addition to the dilemma of possible stigma, in order to be eligible
for legal protection under the ADA, an individual must disclose his or
her disability to the employer and state the need for
accommodations. Drake, Becker, and Bond (2003) note that
accommodations for people with psychiatric disabilities rarely require
direct expenditures on the part of the employer, rather, the
accommodations involve extra supervision, or reallocation of time (such
as scheduling adjustments or additional breaks). In another study
of relationships between employers and people with psychiatric
disabilities, Cook, Razzano, Straiton & Ross (1994) indicated that
when individuals disclosed their mental illness, employers were able to
provide additional support in the areas of job training, job
performance, and supervision. However, Granger, Baron and
Robinson (1997), found that less than half of the respondents with
mental illness referred to the ADA when disclosing their disability to
employers. In a study of disclosure and support provided by
psychiatric rehabilitation practitioners in helping supported employees
understand how to assert their rights under the ADA, 86% of the
participants were unfamiliar with their rights under the ADA and job
accommodations, and that they relied on their job coach or job
developer to arrange job accommodations (Granger, 2000). Another
qualitative study by Giola and Brekke (2003) involving 20 individuals
diagnosed with schizophrenia revealed that only four of the
participants had knowledge of ADA accommodations and referred to these
when disclosing their disability. For these individuals,
disclosure enabled them to better perform essential functions of their
job and access support at the workplace when symptoms arose.
Ellison, M. L., Russinova, Z., MacDonald, K. L., & Lyass, A. (2003)
found that over 87% of study participants working in business,
technical and educational settings disclosed their psychiatric
disability to employers. The issue of disclosure is not often
discussed in the context of multicultural issues (Weston, 2002).
It is possible that patterns of disclosure could be related to
diversity issues in relation to social and personal contexts.
Often, employment specialists also struggle with the matter of
disclosure. Without careful consideration, employment
specialists may reveal unnecessary information about the individual and
his/her mental illness, increasing the supported employee’s issues with
stigma. In contrast, the employment specialist may be too vague
in describing the supported employee and the reasons the individual is
involved in supported employment services, which may subsequently lead
to unanswered questions and potential suspicions on the part of
workplace personnel. Employment specialists need more information
about the ramifications of when, how, who and why disclosure is
necessary. This study takes a first step toward addressing these
issues.
This study explored the role disclosure of mental illness plays in the
employment experiences of people with psychiatric disabilities. Several
research questions guided the investigation:
1. Are there
demographic and disability characteristics that make it more likely
that a supported employee’s psychiatric disability will be disclosed to
workplace personnel?
2. Under what conditions (when, why, and how) is a
psychiatric disability disclosed in the supported employment workplace?
3. Does a disclosure of disability, or the source of
that disclosure, relate to how typical a supported employee’s
employment experiences will be in terms of job acquisition and hiring,
job features, human resources management processes, and social aspects?
4. Is disclosure of disability associated with the
provision of workplace accommodations and coworker supports at the
supported job site?
5. Is disclosure status related to the overall job
adjustment of supported employees with psychiatric disabilities?
A number of hypotheses about the
relationship between disclosure and employment features and outcomes
were set forth. It was predicted that disclosure of a mental
illness would be associated with lower levels of functioning, a less
typical employment situation, and a greater likelihood of workplace
accommodation and coworker support. A non-directional hypothesis
was postulated regarding the relationship between overall job
adjustment and disclosure status.
Method
This multi-site study utilized a survey design to assess the relation
between mental illness disclosure for supported employees and
associated employment features and outcomes. Data for the study
included demographic, disability, disclosure, employment and support
information for 162 supported employees served by 10 mental health
vocational programs across 8 states (CA, IN, KS, NY, OR, PA, RI,
VA). This disclosure study was a supplement to quantitative
research on workplace supports and integration outcomes for people with
psychiatric disabilities (Banks, Charleston, Grossi & Mank, 2001)
which analyzed job performance, psychiatric symptoms, workplace
supports and integration outcomes of 243 individuals with psychiatric
disabilities. The workplace supports study indicated that higher
levels of social integration correspond with higher wages of supported
employees.
Procedures
Administrators of 10 vocational programs for people with mental illness
were initially contacted by telephone and invited to participate in the
research project. Programs were selected based on nominations
from national experts in the field of psychiatric rehabilitation.
All programs were described as having successful employment outcomes
and were considered to be using “natural supports” approaches to
employment service delivery. Natural supports are defined as “any
assistance, relationships, or interactions that allow a person to
secure or maintain a community job . . . in ways that correspond to the
typical work routines and social interactions of other employees”
(Rogan, Hagner, and Murphy, 1993).
Information was provided to agencies about the study purpose, survey
content, and data collection procedures. Agencies were asked to
complete survey forms for all supported employees working in
community-based jobs. The program staff person with the most
knowledge of each supported employee and his or her job situation was
asked to fill out the survey form. Financial remuneration of
$15.00 was offered for each completed survey.
Confidentiality requirements for submitting data were explained prior
to data collection. Reference numbers were assigned to each
survey to protect the anonymity of individuals included in the study.
Administrators of the participating agencies were re-contacted
approximately one year later and asked to complete a follow-up data
form for each of the 243 supported employees included in the original
study. This one-page supplemental data form consisted of
questions about the disclosure of the supported employee’s disability
to workplace personnel. All of the 10 agencies agreed to complete
the disclosure supplements. Supplemental data forms were returned
for 162 of the 243 supported employees. The 33 percent attrition
rate is due, in part, to the fact that some staff who had completed the
original surveys reported that the supported employees were no longer
working or receiving services from the participating agencies.
Participants
The majority of the sample was male (61.7%) and Caucasian (85.8%), and
nearly half of the participants (43.2%) were between the ages of 31 and
40. Greater than half of the sample (58.7%) lived independently
while 27 percent resided with parents or other family members and 14
percent lived in a supervised or supported residential setting such as
a group home, supervised apartment or supported living setting.
The most prevalent primary disability diagnoses were schizophrenia and
other psychotic disorders (47.2%) and affective disorders
(36.5%). The mean Global Assessment of Functioning (GAF) score
for participants was 59.42 (SD = 9.3). GAF is a rating of overall
psychological functioning on a scale of 0-100. According to the DSM-IV,
a GAF score between 51 and 60 indicates moderate symptoms or moderate
difficulty in social or occupational settings (American Psychiatric
Association, 1994). GAF scores were obtained from the
participants’ most recent clinical record. Nearly 20 percent of
the sample (n = 32) had GAF scores indicating serious symptoms or
impairment in functioning while 40 percent (n = 65) had GAF scores
indicating minimal to mild symptoms. Demographic and disability
characteristics of the subset of 162 persons for whom disclosure
supplements were returned were similar to those of the original sample
of 243.
Instruments
Natural Supports Survey. The natural supports survey for
employees with mental illness was adapted from an earlier 62-item
survey designed for participants with developmental disabilities.
A detailed description of the design and development of this previous
survey instrument is provided in Mank, Cioffi, and Yovanoff
(1997). A panel of experts was consulted to help tailor the
survey instrument for use with employees with psychiatric
disabilities. Modifications to the original survey included
changes to items about disability diagnosis and the addition of items
about level of functioning, workplace accommodations, level of indirect
employment support, service delivery model type, and community
connections and supports. The natural supports survey for
employees with mental illness was pilot tested with four community
mental health agencies to assess item content, scope, and
clarity. The final version of the survey included 85 items
covering five general areas: demographics, disability information,
employment features and outcomes, company personnel, and community
connections and supports. Further description of survey content
is provided in Banks et. al., (2001).
Disclosure Supplement. The Disclosure Supplement was developed as
a follow-up questionnaire to the Natural Supports Survey. The
primary purpose of the supplement was to determine which supported
employment participants from the original sample disclosed their
disability to workplace personnel. The 5-item supplement also
requested information about the circumstances surrounding
disclosure. Response categories for each question were developed
based on a review of the relevant literature and suggestions from the
expert panel.
Measures
Of particular interest in the present study were variables related to
(a) disability disclosure, (b) level of functioning, (c) typicalness of
employment features, (d) workplace accommodations and coworker support,
and (e) overall job adjustment.
Disability disclosure. Disability disclosure status was measured
as a dichotomous variable (disclosure/no disclosure). For
supported employees whose disability was disclosed to workplace
personnel, respondents were asked to indicate when, why, and how the
disclosure was made. In addition to the predetermined response
categories for each question, an “other” category was included to allow
for additional responses.
Level of functioning. Level of functioning was assessed in two
ways: Global Assessment of Functioning (GAF) scores and a measure of
severity of psychiatric symptoms at the worksite. GAF scores were
gleaned from the supported employee’s most recent clinical
record. Severity of psychiatric symptoms at the worksite was
rated on a 4-point scale (none, mild, moderate, severe).
Typicalness of Employment Features. Respondents were asked how
“typical” the employment experiences of the person with a disability
were compared to those of employees without disabilities in the same
work setting. A 7-point scale (1 = not typical, 7 = quite
typical) was used to rate the typicalness of 24 features of
employment. For example, respondents were asked to rate “how
typical” the individual’s job application process was compared to that
of other job applicants. If the individual with a disability was
required to submit the same formal job application that other
prospective employees are required to submit, then this would be quite
typical. If, however, other prospective employees are required to
fill out a formal job application while the person with a disability
was not required to do so, then the application process would be
considered atypical. The 24 typicalness items were organized into
four item clusters: job acquisition and hiring (e.g., recruitment, job
application, interviewing), job features (e.g., work schedule, hourly
pay, break times and location), human resources management processes
(e.g., initial job training, supervision, opportunities for promotion),
and social aspects (e.g., participation in non-work and at-work social
activities). The scale was not designed as a value judgment but,
rather, a comparison between the typical experiences of employees with
and without disabilities.
Factor analysis was used to analyze the correlational structure of the
typicalness items. This was done in order to reduce the total
number of variables required to describe the underlying dimensions of
typicalness (Tabachnick & Fidell, 1996). A maximum likelihood
solution with varimax rotation indicated the presence of four distinct
factors with eigenvalues greater than 1.0, capturing 71 percent of the
total variance in scores. The factor solution was somewhat
satisfactory, although a simple structure was not attained as some
variables loaded onto more than one factor. Criterion for loading
was .45. One item (i.e., transportation) was dropped due failure to
load on a factor. The factor structure closely mirrored the
section breaks in the survey itself. A principal components
analysis yielded similar results.
Following factor analysis, Cronbach’s alpha coefficients were
calculated for each of the four resultant subscales. Coefficient
alphas for the subscales ranged from .86 to .95 and suggested a high
degree of internal consistency. One item (i.e., amount of
task-related interaction with coworkers) was dropped from the Social
Aspect subscale because it did not add to internal consistency
alpha. Table 1 presents item loadings of the rotated 4-factor
solution and internal consistency coefficients for each subscale.
Table
1 Factorial Structure
of Typicalness of Employment Items
|
Items
|
Factor
|
|
Job
Acquisition
|
Job Features
|
Management
Processes
|
Social Aspects
|
|
Interviewing
|
.89
|
.12
|
.22
|
.15
|
|
Job
application
|
.76
|
.24
|
.12
|
.04
|
|
Recruiting
|
.73
|
.16
|
.34
|
.24
|
|
Role in
choosing job
|
.64
|
.19
|
.44
|
.30
|
|
|
|
|
|
|
|
Company
benefits
|
.10
|
.83
|
.08
|
.20
|
|
Break
location and schedule
|
.20
|
.72
|
.19
|
.22
|
|
Hourly pay
|
.14
|
.58
|
.41
|
.11
|
|
Others do
similar work
|
.21
|
.55
|
.35
|
.14
|
|
Opportunity for job
variety
|
.29
|
.49
|
.41
|
.41
|
|
Work schedule
|
.16
|
.45
|
.41
|
.27
|
|
|
|
|
|
|
|
Disciplinary
process
|
.24
|
.27
|
.81
|
.26
|
|
Layoff
conditions
|
.23
|
.34
|
.74
|
.25
|
|
Support in
time of crisis
|
.23
|
.10
|
.71
|
.36
|
|
Supervision
|
.27
|
.20
|
.70
|
.25
|
|
Work rules
and expectations
|
.24
|
.30
|
.66
|
.39
|
|
Performance
evaluation
|
.26
|
.45
|
.66
|
.14
|
|
Orientation
or induction
|
.39
|
.26
|
.57
|
.33
|
|
Opportunity for
promotions
|
.26
|
.44
|
.57
|
.31
|
|
Initial job
training
|
.45
|
.16
|
.48
|
.37
|
|
|
|
|
|
|
|
Participation
in at-work social activities
|
.17
|
.23
|
.16
|
.94
|
|
Participation
in non-work social activities
|
.11
|
.26
|
.32
|
.79
|
|
Behaves
within accepted social norms
|
.19
|
.07
|
.42
|
.58
|
|
|
|
|
|
|
|
Cronbach’s
coefficient alpha
|
.90
|
.86
|
.95
|
.89
|
Factor scores were computed using items identified with factor analysis
and Cronbach’s alpha coefficients. Participant responses to items
comprising each typicalness factor were averaged to compute four
separate factor scores for each participant. Calculating an
average rather than a sum of item responses maintained the 1 (not
typical) to 7 (quite typical) scale, simplifies interpretation of
factor scores.
Workplace accommodations and coworker support. Respondents were
asked if workplace accommodations were in place for supported
employees. They were also asked to identify the specific
accommodations by using a checklist. Examples of accommodations
include job restructuring, flex time, self-management tools, physical
changes to the immediate work environment, and additional supervisor
feedback. Coworker support was operationalized by two questions:
(a) was training and support provided to company personnel? (yes/no),
and (b) did company personnel provide support to the employee with a
disability? (yes/no). Examples of support provided to company
personnel include general disability awareness training or training
specific to the support needs of the employee with a disability.
Examples of support provided by company personnel include helping the
supported employee learn new tasks, meet productivity standards,
maintain socially appropriate behavior, participate in social
activities at work, or manage job-related stressors.
Overall job adjustment. Job adjustment was defined as the extent
to which the supported employee has adjusted to the job following
initial training. Six items measuring job adjustment (e.g., work
rate is comparable, relationships with coworkers are positive, employee
seems satisfied with job) were scored on a scale of 1 (a little) to 7
(a great deal). Responses to items were averaged to compute a
composite score on overall job adjustment for each participant
(Cronbach’s alpha = .91).
Data Analysis
Two sets of analyses were performed to investigate the disclosure of
psychiatric disability and associated employment features and
outcomes. In the first set of analyses, univariate tests of group
differences were used to examine differences between the
characteristics of supported employees whose disabilities were
disclosed and characteristics of supported employees whose disabilities
were not disclosed. Following a significant 2, standardized
residuals were examined to determine which cells contributed most to
the significant 2 value. Descriptive statistics regarding how, when,
and why a disability were disclosed were also calculated.
The second set of analyses examined whether disability disclosure
variables were associated with differential employment features and
outcomes. This set of analyses was performed in three
steps. First, t-tests were conducted to study the relation
between disclosure variables (disclosure status and disclosure source)
and typicalness of employment variables (job acquisition, job features,
management processes, and social aspects). Second, multiple response
crosstabs were examined to determine whether company personnel
variables differed by disclosure status. Third, a univariate
analysis of variance was conducted to determine if overall job
adjustment was related to disclosure status. With regard to
ethnic diversity, there was a small number of non-caucasian
participants (N=17), which is less than 15% of the sample of
participants.
Results
Initial findings of the Natural Supports Study focusing on the
relationships between mental health diagnosis, workplace supports, and
supported employment outcomes have been reported previously by Banks,
Charleston, Grossi, and Mank (2001). The results reported here
examine disability disclosure in the supported employment workplace and
its relation to employment features and outcomes.
Disability Disclosure
Which supported employees disclosed? A disclosure of disability
was made for 82 percent of the supported employees in the present
study. Employees who disclosed differed from those who did not
disclose on a number of demographic and disability characteristics (see
Table 2). Employees were significantly less likely to have
disclosed their disability if they were women, had a mood disorder, or
displayed no psychiatric symptoms at work. Employees who
disclosed did not differ significantly from those who did not disclose
in terms of ethnicity, age, living arrangements, or Global Assessment
of Functioning (GAF) score.