Executive Summary

Case Studies on Reasonable Accommodations for Workers with Psychiatric Disabilities By Laura L. Mancuso, MS, CRC June 1993

The employment provisions of the Americans with Disabilities Act (ADA) took effect in July 1992. Among the nearly 10,000 complaints filed to date with the U.S. Equal Employment Opportunity Commission, mental illness is the second most frequently cited type of impairment. At the same time, anecdotal reports indicate that while businesses are improving the physical accessibility of their facilities, many are uncertain about how the ADA applies to applicants or employees with psychiatric disabilities.

Some aspects of the ADA are unprecedented. However, many of the employment provisions closely follow the policy and precedents established under Title V of the Rehabilitation Act of 1973. This experience indicates that while we are just beginning ADA implementation, we have much to learn from current business practices.

The purpose of this study is to document the employment experiences of 10 workers with psychiatric disabilities, including their use of workplace accommodations. Information was gathered through in-depth, face-to-face interviews of the workers and their supervisors. In each case, the worker's disability was known to the employer. Supported employment service providers were involved in 5 of the 10 work situations. Direct quotes are prominently featured throughout the report and areas for further investigation or research are identified.

Major findings include the following:

Decisions about whether or not to disclose one's psychiatric disability to an employer, when to disclose, to whom, and what to say, may be the most delicate and complex area of ADA implementation for workers with psychiatric disabilities. Interviewees described some potential risks and benefits of disclosure.

There was no consensus among the workers interviewed as to whether or not they would advise other people with psychiatric disabilities to inform their employers that they have disabilities. Several interviewees recommended that workers should wait until they have established a reputation as a valued employee before disclosing.

The functional limitation most frequently cited by workers with psychiatric disabilities was difficulty with concentration. Several workers also commented on the effects of stress on their job functioning.

Functional limitations resulting from the side effects of psychotropic medications were common. In some cases, medication effects were the only work-related limitations associated with the psychiatric disorder.

In general, the workers perceived their functional limitations to be greater than did their supervisors.

Accommodations were developed through informal, and sometimes one-sided, processes. The author identifies and labels several categories of accommodations:

Explicit accommodations - in which both the worker and his/her supervisor concurred on the accommodation being made - occurred in only two instances.
Unilateral accommodations by the employer - in which the supervisor reported making modifications without the participation of the employee - occurred in 4 of the 10 employment situations examined.
Four workers described practices they have developed to compensate for or cope with their psychiatric disabilities on the job (of which the employer was unaware). One worker called them self-accommodations.
In five instances, the employers described mutually beneficial arrangements that might be termed, productivity accommodations because they might have been made to enhance the productivity of any worker, whether or not he/she had a disability.

Although half of the workers were assisted by job coaches during at least part of their job tenure, participation in supported employment was rarely described as a reasonable accommodation.

The accommodation most often cited by workers was a flexible or part-time schedule. Employers most frequently cited modifications in work assignments or other supervisory interventions, as well as flexible or part-time scheduling.

None of the employers described being asked to provide accommodations that would have imposed an undue hardship.

Workers described some negative social and/or personal consequences from receiving reasonable accommodations in the workplace.

With some exceptions, the employers were generally ill-informed about the ADA's employment provisions. Many covered entities may be receiving information only through television news shows or newspaper articles.

None of the employers appeared to be making accommodations in order to comply with the law. Rather, they tended to implement accommodations because they made good business sense.

The study was funded by the Community Support Program of the Center for Mental Health Services. Its dissemination was supported by a cooperative agreement between the California Department of Mental Health and the California Department of Rehabilitation.

To obtain a copy of the MI report (in print, large print, or audio cassette), contact:

Reasonable Accommodations Report
California Department of Mental Health
Attn: Publications
1600 9th Street, Room 250
Sacramento, California 95814
(916) 654-2678

The author welcomes your comments on the report. You may contact Laura Mancuso at 946 West Campus Lane, Goleta, CA, 93117, (805) 685-9077.

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For F.M.
May the inner light illuminate the path of your recovery

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