Severe Psychiatric Disabilities and Employment

Anti_Stigmatization2.jpgThere are many people with common neurotic anxiety disorders who continue to work despite their condition, depending on severity. However, people with more serious psychiatric disabilities such as schizophrenia or bipolar I disorder, often drop out of the workplace when their mental condition reaches a critical level. Those with such severe psychiatric disabilities usually have difficulty just trying to get through the day! Without being able to work, they often deplete their assets and must either rely on government programs for assistance, if they can qualify, or may have nowhere to live unless family or friends will take them in.

It is at this point that the seriously mentally ill person needs others the most. Family members often have to help their relative with everyday activities, transportation, housing or financial assistance. Yet the stigma of being seriously mentally ill can prevent others from wanting to help. The perception is that this person brought on these troubles herself; she may be a “bottomless pit” of need; she is dangerous to live with; and she is better off left to government assistance programs.

National Alliance for the Mentally Ill found that 85% of people with serious mental illness are unemployed. (1) Only 30-40% of people with serious mental health problems are capable of holding down a job, so this means that the majority are not capable of working. (2) Still, if the person needs employment and wants to try to work, the prejudices and stigmatization from employers makes this task difficult. Many employers have concerns over job performance and attendance, and don’t wish to increase their health insurance costs by hiring people with psychiatric disabilities. The high unemployment rate among the mentally ill is due partly to this stigmatization at the workplace.

Sometimes the seriously mentally ill person is not the best judge of whether or not she can work because she is not aware of her own behaviors. Others may have to point out that some of the things she says or does will not fit into the workplace. (3) This may leave her in a desperate situation because although she may not be able to work, she may have no choice but to try anyway.

So what we see is that the seriously mentally ill person might have difficulty just getting through the day with her mental suffering, may have little or no money, and if she tries to make the effort of looking for work, she will risk further rejection which adds to mental suffering.

But how hard is it to get a job? Many individuals do not even disclose a mental illness for fear of discrimination. “One-third of people with mental health problems report having been dismissed or forced to resign from their job because of their previous psychiatric history and more than two-thirds had put off applying for jobs for fear of unfair treatment.” (4) But if the seriously mentally ill person is honest with the prospective employer about her illness, the Americans with Disability Act demands that she is not discriminated against and reasonable accommodations must be made. But in real life, if the employer doesn’t want to hire that person, there are plenty of excuses to not hire her. The benefit of disclosing the illness during the interview process, however, is that the law does stand behind the mentally disabled person and if she needs special accommodations or time off from work if hired, then she will more likely receive what she needs. Yet many employers cannot offer the degree of flexibility needed by the mentally ill employee, just by the nature of the job.

Fewer than four in ten employers say they would hire someone who is mentally ill. (5) Reasons given for excluding people with mental illnesses from steady work range from concern over job performance and attendance, to fears about rising healthcare and insurance costs. “Many employers and employees have unwarranted fears and see persons with psychiatric disabilities as unskilled, unproductive, unreliable, violent or unable to handle workplace pressures.” (6)

Even if they are hired, and manage to perform their job tasks adequately, they face additional barriers such as co-workers being disturbed about working alongside someone who has a psychiatric disability. A person with bipolar disorder, for example, may enter a manic phase and behave erratically, which confirms the co-worker’s fears.

The seriously mentally ill person also faces the stress of doing the job itself. “Unlike people with a physical health problem who tend to take time off, those with mental health problems go to work but require greater effort to function.” (7) There is additional stress if she hid her illness and its symptoms. This stress is related to lying to the employer and fears of being found out. Yet there are still benefits to working, even if it is difficult. One benefit of working is that the mentally ill “report that they are use hospital and crisis services less when they are working than they did when they were not working.” (8) Other benefits include gaining a sense of stability, there is social interaction available and the boost to self-esteem they need helps improve their mental state.

So is it worth it?

  • Work for people with serious mental illness tends to be sporadic, poorly paid and lacking employee benefits.” (9)
  • Few jobs available to people with mental illnesses have mental health care coverage, so those individuals receiving government assistance may be forced to choose between employment and access to mental health care.
  • A US report found that 43 % of federal employers and 22 % of private employers cited negative attitudes of supervisors and coworkers toward people with disabilities as a barrier to continued employment and advancement. (10)
  • Although there are benefits to working, the work itself may also cause the illness to grow worse because of stress.

With these barriers to employment, it is understandable why so many of those with severe psychiatric disabilities remain unemployed, caught in a desperate cycle of poverty and social isolation which neither their families nor the business world can depended upon to alleviate.


Canadian Mental Health Association, Thunder Bay Branch, Facts About Work and Mental Illness (2001).


(1) Nobel, Jr., John H. et al.(09/14/00) NAMI. A Legacy of Failure: the Inability of the Federal-State Vocational Rehabilitation System to Serve People with Serious Mental Illness.

(2) Boardman, Jed. (2003) British Journal of Psychiatry. Advances in Psychiatric Treatment. Work, Employment and Psychiatric Disability. 9: 327-334

(3) Long, Phillip W., M.D. Mental Illness and Work. Canadian Psychiatric Association. Copyright 1995-2005

(4) Office of the Deputy Prime Minister, Social Exclusion Unit. Employment and Mental Health. Copyright 2004.

(5) Office of the Deputy Prime Minister. Mental Health and Social Exclusion. June 2004.

(6) Long, Phillip W., M.D. Mental Illness and Work. Canadian Psychiatric Association. Copyright 1995-2005

(7) Dewa, C.S. and E Lin (July 2000) Chronic Physical Illness, Mental Disorder and Disability in the Workplace. Social Science and Medicine 51(2000) 41-50

(8) Trainor, John et al. (Sept. 1996) Consumer/Survivor Development Initiative Evaluation Report, Ontario.

(9) Can Health Services Research Influence Public Policy and Private Actions? Mental Illness and the Workplace. Conference sponsored by the Association of Health Services Research and NAMI. Dec. 8-9, 1999

(10) Livingston, Sandra. (July 23, 2000) The Plain Dealer, Cleveland Ohio.

  • DisabilityAdvocate

    This is the truth! It is so tough for the mentally disabled that are being medically treated to get any decent work. Things have to change to better the treatment of the ill. Thanks for reporting this and standing for us!

  • I am one of the 85% of those with serious mental illnes to be unemployed. Though I have had Biopolar Illness my whole life I ws not doagnosed until my 45th birthday. That was 11 1/2 years ago and I still am unable to work. I am only too well aware of what it would take for me to get a job and I am simply not up to the task. I seriously doubt that I will ever be able to be self-sufficient again, partly due to the illness, and partly due to the insane rules of SSI where there is a resource cap and so it is next to impossible to ever save enough to get off assistance. It’s really a double bind, and this is true even if I were to somehow find a job I was cap[able of working. I agree – things have to change. Thanks for your article.

  • Elise Stobbe

    Yes, it takes a lot for the mentally ill to get a decent job. I hope blogs like this can play a part in raising awareness of this issue.

  • Appreciate your blog,mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it’s Zyprexa product causing my diabetes.–Daniel Haszard

  • It is true that a large portion of people with mental health diagnoses are not in the workforce; however, as I note on my own blog, stigma, stereotypes (including those set out by other mental health consumers), a lack of action on the part of government and legislated poverty make it even worse and the unemployment/poverty rate more stagnant.

    There are many mh consumers that can work, but don’t because they are steered to jobs that are too low-paid, beneath their education/skills level or they are afraid of being discriminated against in the workplace, which as your article states is more likely to happen than not happen. Rather than accepting that “people can’t work” I say let that person decide and let the system develop necessary supports to work with them. Right now, social assistance rates are TOO LOW to remain out of the workforce … unless the government raised the rates by approximately 40% overnight, 90% of people with mh disabilities will not be able to afford to find a place to live, let alone eat properly – only spiraling them further into a cycle of desperation. Social assistance is NOT a suitable alternative unless it provided enough to live on.

    Both employers and employment agencies alike better start thinking that people with mh disabilities come with the same range of skills and abilities as any other group. There are people among this population with university educations who are referred to minimum wage jobs that have little to no opportunity for advancement, which is again why many are out of the workforce … I engineered a program several years ago that saw to it many mh consumers were able to start and operate their own small businesses, a few of whom were able to advance to the stage of hiring their own staff.

    Maybe a few may be incapable of working, but I think if we started opening doors and looking for the positives instead of finding excuses (esp. from the employers that won’t open their minds or employment agencies that think mh consumers of all stages of their life are only capable of working in the five f’s: food, filth, filing, fetching and flowers), things can change. There are studies that show capacity to work increases with degree of community acceptance and support. We have yet to see that in the U.S. or Canada. All I see are opportunists taking over the leadership roles, accepting high salaries and doing nothing with their resources to improve the quality of life for all. I think the need to account for all of this is NOW.

    Come visit my website.

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