Introduction

The Americans with Disabilities Act of 1990 (ADA) enacted broad non-discrimination protections for workers with disabilities, including those with psychiatric disabilities. The employment provisions, which took effect on July 26, 1992, prohibit discrimination on the basis of disability in virtually all aspects of employment. As in Title V of the Rehabilitation Act of 1973, the ADA requires employers to make reasonable accommodations for qualified applicants or employees with disabilities. But unlike the Rehabilitation Act, which only covered employers receiving grants, contracts, or other financial assistance from the federal government, the ADA now extends nondiscrimination requirements to all employers with 25 or more workers. Beginning two years later on July 26, 1994, employers with 15 or more workers must comply.

Although the final version of the ADA was passed with broad bipartisan support in both the House (377 to 28) and Senate (91 to 6), the bill included no spending authorizations. Furthermore, the federal government agencies charged by Congress with responsibility for regulation, enforcement, and technical assistance were not given substantially increased resources during the ensuing appropriations cycle, despite the anticipated growth in workload. While the ADA is now law, and several federal agencies have diverted existing resources to focus on its implementation, very limited funding is available for training and technical assistance.

Anecdotal reports indicate that many employers have initiated ADA compliance by surveying their physical plants and correcting deficiencies in accessibility for individuals with mobility impairments. Secondly, many are reviewing their employment application forms and job descriptions for compliance with the ADA. While some employers seem comfortable with their ability to accommodate applicants or employees with physical disabilities, many express discomfort and uncertainty about how the law applies to persons with psychiatric disabilities. Indeed, some are not even aware that persons with mental impairments are covered by either the ADA or the Rehabilitation Act. But mental illness has consistently been the second most frequently cited type of impairment in complaints filed with the U.S. Equal Employment Opportunity Commission (EEOC) since the employment provisions of the ADA took effect (surpassed in frequency only by back impairments).

Many people with psychiatric disabilities may be unaware of their rights under the ADA. There is evidence that information about Title V of the Rehabilitation Act was slow to reach individuals with disabilities. Nearly a decade after the regulations for Section 504 took effect, a survey of American adults with disabilities, conducted by Louis Harris & Associates, found that only 31 percent were very familiar or somewhat familiar with its provisions.¹ Certainly the impact of a nondiscrimination law is limited if the citizens granted protections are not aware of their rights.

Given the general dearth of information about ADA implementation and the specific confusion about how the law applies to persons with mental impairments, there is a need for more information about how workers with psychiatric disabilities may be accommodated. The potential audience for this information includes individuals with disabilities, employers, and mental health/ employment service providers.

Shortly before the employment provisions of the ADA took effect in 1992, the Community Support Program (CSP) (which at that time was part of the National Institute of Mental Health but has since moved to the Center for Mental Health Services) initiated this project to gather information about current practices in reasonable accommodation for workers with psychiatric disabilities. While preliminary categorizations of accommodations had already been published, there were no comprehensive analyses of the context in which accommodations are made, how they are negotiated, how they change over time, or the effects of disclosing a psychiatric disability in the workplace.

The case studies presented here are based on in-depth, face-to-face interviews of 10 workers with severe psychiatric disabilities and their supervisors. In each instance the employer was aware that the worker had a disability, and some type of accommodation had been made. The project's aim was to supply information for use by CSP in providing telephone and written consultation to the field on the context and development of effective reasonable accommodations. The ultimate purpose of the project is both to assist in implementing the ADA and to further the goal of CSP in promoting approaches to increase employment of people with psychiatric disabilities.

Several themes emerged from the content of the interviews. The structure of this report reflects those themes:

1.   disclosure,
2.   functional limitations experienced by some workers with psychiatric disabilities, and
3.   reasonable accommodations.

The findings described here are illustrative of the issues surrounding reasonable accommodations and the implementation of the ADA for workers with psychiatric disabilities. While this study lacks the precision of quantitative research, it contributes to our understanding of employment for people with psychiatric disabilities through detailed characterizations of the experiences of ten people representing a range of employment circumstances. It also offers a medium for mental health consumers to speak for themselves, by describing their own experiences and reflections. This form of qualitative research mirrors the condition and complexity of ADA implementation today.

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