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.