Bipolar Disorder in the Workplace

[David Baxter PhD]

Part I: Will I Be Able to Return to Work?
By Candida Fink MD
December 8, 2009

Nobody can tell you whether you will be able to return to work. The answer hinges on several variables, including the severity of the illness, the effectiveness of the treatment you receive, how much support you have at work and home, the stress level (and your capacity for handling it), and how eager you are to return to work.

You might be better off rephrasing the question. Instead of asking ?Will I be able to return to work?? Ask yourself what returning to work means for you:

• Full return: Some people with bipolar take a few weeks or months off work, obtain the medications or other treatments they need, and then return to work as though nothing had happened.
• Partial return: Instead of returning to your standard 40- to 50-hour workweek, you scale back, perhaps working only 3 or 4 days a week if your situation allows for it. Some people who take this approach find that they can, over time, build back up to working a full week.
• Return with accommodations: The ADA (Americans with Disabilities Act) covers mental illness, so whether you return full-time or part-time, you may qualify for reasonable workplace accommodations. We cover this in detail in Part IV of this series, ?Requesting Workplace Accommodations.?
• Job change: Instead of returning to the same job, you may be able to secure a less demanding position with the same employer, seek employment elsewhere, or change careers.

Experiencing a major mood episode is often likened to being in a serious car accident. You may not look bruised and battered on the outside, but your brain has suffered serious trauma and needs rest to fully recover. In addition, you?re probably taking some new medications, which often require at least a few weeks to become effective and perhaps even more time for your body to adapt to them. In short, try not to be in too much of a hurry to get back to work.

You are much more likely to have a successful return to work by taking all the time you need to fully recover and get your moods on an even keel. A premature return increases your chances of experiencing another crash, which may make returning to work even more difficult next time.

Also ask yourself whether you can afford not to work. I am not talking just about money and benefits. Work offers a host of perks, including the following:

• Structure: Bipolar often responds better in a structured environment, particularly in terms of schedule, and a workday can provide this structure.
• Positive self-esteem: Being productive naturally provides you with a sense of self-worth.
• Camaraderie: For many people, work is the place where they socialize the most, and having an active social life (not too active), can level out your moods and provide support as you set work-related recovery goals and develop adaptive habits.

Don?t underestimate the value of these benefits when making your decision. But if bipolar prevents you from returning to work, don?t assume that you?re losing out on all this great stuff, either. You can structure your day, establish a healthy social life, and build self-esteem without a job ? it just may be a little more challenging. These activities may take the form of volunteerism, new roles within your family, adult education, or avocational pursuits, such as gardening, book clubs, and art, or music.

 

[David Baxter PhD]

Returning to work: To Tell or Not to Tell?

Bipolar on the Job Part II: To Tell or Not to Tell?
By Candida Fink MD
December 15, 2009

The question of whether to disclose one?s bipolar disorder to an employer often causes anxiety for the person with the illness. Of course, it shouldn?t be that way. If you were ill with cancer, diabetes, or heart disease, you would probably disclose it without reservation. You might even get some sympathy. People with mental illness, however, often fear the real possibility of being stigmatized. Stigmatization can take several forms:

• Getting fired or ?let go?
• Getting passed over for promotions
• Being excluded from social gatherings by coworkers
• Worrying about people?s perception of you or that they pity you or are watching you
• Having co-workers attribute certain things you say or do (things that would be considered normal for others) to the illness
• Being denied or losing health insurance coverage

In the best case scenarios (with employers who value their employees and understand that good people often have health issues that need to be managed), disclosing your condition can benefit you in several ways:

• You no longer have to carry the burden of hiding your illness.
• You become eligible under the Americans with Disabilities Act for special accommodations. (The employer must be aware of any disability in order to be held legally accountable for providing workplace accommodations.)
• Your supervisor and any co-workers you tell may be more willing and able to offer assistance if they understand what?s going on.
• In educating others, you are likely to learn much more about bipolar yourself and feel more empowered.

We cannot tell you whether disclosure is the right thing or the best thing in your particular situation. You may be able to gauge how receptive your supervisor and co-workers will be by considering at their past behaviors and comments they have made about mental illness. If they have demonstrated empathy for others who have had similar conditions, you can safely predict that they will treat your situation with care and understanding, as well.

According to Laurel Radley, Associate Director of Professional Affairs for the American Occupational Therapy Association, more often than not, people with bipolar disorder and similar conditions who choose to disclose their illness are happy they did. ?People often assume that they are the only ones dealing with challenges like these,? says Radley. ?But when they mention having bipolar or depression or other conditions, the person they?re telling often opens up about similar challenges in their own lives or in their family. It becomes a conversation starter that can lead to productive dialogue. Seeing that others really do understand and care about you can be very reaffirming.?

Radley recommends starting with the people you trust most and those who seem to be more understanding. As these people become more aware of what is going on and better informed, they join your support network and can help fight the stigma.

For more about the pros and cons of self-disclosure, you can access a 50-page booklet on the topic entitled Self-Disclosure and Its Impact on Individuals Who Receive Mental Health Services. (Hyman, I. HHS Pub. No. (SMA)-08-4337 Rockville, MD. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2008.)

 

[David Baxter PhD]

Bipolar on the Job Part III: How to Talk About Bipolar Disorder

Bipolar on the Job Part III: How to Talk About Bipolar Disorder
By Candida Fink, MD
December 22, 2009

Most of the population has managed to overcome obstacles in talking about a host of healthcare issues previously considered taboo in ?polite company.? Some people, however, still have hang-ups when it comes to discussing mental health issues. They can?t seem to accept the fact that the brain, like other organs of the body, can become ill. When they observe the symptoms of an ill brain ? which can manifest as socially unacceptable language or behavior ? they blame the person rather than the illness. Most of this is due to ignorance, and the best way to combat that is through education.

When you?re the one who?s ill, you shouldn?t have to invest time and energy educating uninformed others about your illness. They should already understand and demonstrate some empathy, if not sympathy. The reality, however, is that if you don?t educate and advocate for yourself, your situation at work (or home or school or wherever) is not likely to improve. The more others know about bipolar, the less fearful and more accepting they will be.

So, how do you go about educating your supervisor, colleagues, and others at your workplace? Here are some suggestions:

• Play the role of teacher. Take a non-confrontational approach to presenting the facts about bipolar.
• Start by disclosing your condition to the people you trust most and those who seem more understanding and open minded.
• Keep in mind that you control exactly how much you choose to disclose to each individual. You don?t have to tell everyone everything. Readiness to receive information varies depending on the individual.
• If your employer has a human resources department, consider involving the HR staff in meetings with your supervisor. HR people should know employment law and be able to ensure that you receive any reasonable accommodations you request.
• Describe the way you feel when you are depressed or manic. Nobody can argue or become defensive when you simply describe how the disorder makes you feel.
• Describe common symptoms you have. How is your behavior likely to change when you?re becoming manic or depressed? By describing symptoms, you accomplish two things. First, you let people know what to expect, so they are better prepared to handle any behavioral changes. Second, you enlist them in helping you spot early warning signs, which you may not notice when you?re feeling manic or depressed.
• Be sure to mention that not everything you say and do can be attributed to bipolar. You don?t want a bunch of bipolar police sounding the alarm every time you raise your voice. Let them know that when you?re healthy, you can be sad, angry, energetic, tired, frustrated, and so on, just like anybody else. Most people with bipolar want to be treated ?just like everyone else.?
• Point out the fact that with treatment your symptoms remain in control most of the time.
• Keep in mind that it may take some time for the people you tell to absorb the information you provide and even longer for them to accept it and change as a result.

Tip: If your company has in-services or guest speakers, consider inviting a psychiatrist, therapist, or qualified individual from a local mental health group to speak or lead a discussion about mental illness ? specifically bipolar disorder.

 

[David Baxter PhD]

Part IV: Requesting Reasonable Workplace Accommodations

Part IV: Requesting Reasonable Workplace Accommodations
By Candida Fink MD
December 29, 2009

When you receive a bipolar diagnosis (and disclose it to your employer), you gain protection under the law via the Americans with Disabilities Act (ADA). As long as your employer is on notice of the problem and you?ve expressed some desire to get help, your employer is required to engage in a dialogue with you to determine whether reasonable accommodations would enable you to perform the essential functions of the job.

When most people first hear about the ADA, they mistakenly assume that it?s restricted to physical disabilities, such as not being able to lift something heavy or walk up a flight of stairs. However, as Substance Abuse and Mental Health Services Administration (SAMHSA) points out in its online publication entitled Filing an ADA Employment Discrimination Charge: Making It Work for You:

? the law is for people with psychiatric disabilities, too. It forbids discrimination against people with both physical and mental disabilities in employment, transportation, public facilities, and public communications. The ADA?s employment requirements are especially important for people with psychiatric disabilities. This is because many employers share society?s fear, prejudices, and lack of information about mental illness.​

To qualify for protection under the ADA, your situation must meet the following conditions. You?

• Have a physical or mental impairment that substantially limits one or more of your major life activities
• Have a record of such an impairment (your diagnosis, for example) or are regarded as having such an impairment
• Are otherwise qualified to perform the job duties; that is, you must meet the skill, experience, education, and other job-related requirements of the position, and with reasonable accommodations be able to perform the essential functions of the job

This brings us to the question of accommodations, and reasonable ones at that. Here?s SAMHSA?s definition of reasonable accommodations:

Accommodations are changes to the work environment or the way things are usually done that allow an individual with a disability to enjoy equal employment opportunities. An accommodation is not considered reasonable if it creates an ?undue hardship? for the employer. Undue hardship refers not only to financial hardship, but also to accommodations that are overly extensive or disruptive, or that would change the nature or operation of a business.​

The U.S. Equal Employment Opportunity Commission offers a free booklet on what are considered ?reasonable accommodations? complete with instructions on how to go about requesting them: Enforcement Guidance: Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act. Before you spend the weekend wading through that publication, however, you might want to check out the Job Accommodation Network?s Accommodation and Compliance Series: Employees with Bipolar Disorder by Kendra M. Duckworth. This publication can help you identify accommodations that people with bipolar disorder find particularly helpful. The article groups the accommodations to address particular issues, as presented in the following sections.

Maintaining Stamina during the Workday

• Flexible scheduling
• Allow longer or more frequent breaks
• Provide additional time to learn new responsibilities
• Provide self-paced work load
• Provide backup coverage for when the employee needs to take breaks
• Allow time off for counseling
• Allow for use of supportive employment and job coaches
• Allow employee to work from home during part of the day or week
• Part time work schedules

Maintaining Concentration

• Reduce distractions in the work area
• Provide space enclosures or private office
• Allow for use of white noise or environmental sound machines
• Increase natural lighting or provide full spectrum lighting
• Allow the employee to work from home and provide necessary equipment
• Plan for uninterrupted work time
• Allow for frequent breaks
• Divide large assignments into smaller tasks and goals
• Restructure job to include only essential functions

Difficulty Staying Organized and Meeting Deadlines

• Make daily To-Do lists and check items off as they are completed
• Use several calendars to mark meetings and deadlines or one central one, depending on circumstances and individual needs (multiple organizing tools can sometimes be counter-therapeutic ? overwhelming or confusing)
• Remind employee of important deadlines
• Use electronic organizers
• Divide large assignments into smaller tasks and goals

Working Effectively with Supervisors

• Provide positive praise and reinforcement
• Provide written job instructions
• Develop written work agreements including the agreed upon accommodations, clear expectations of responsibilities and the consequences of not meeting performance standards
• Allow for open communication to managers and supervisors
• Establish written long term and short term goals
• Develop strategies to deal with problems before they arise
• Develop a procedure to evaluate the effectiveness of the accommodation

Difficulty Handling Stress and Emotions

• Provide praise and positive reinforcement
• Refer to counseling and employee assistance programs
• Allow telephone calls during work hours to doctors and others for needed support
• Provide sensitivity training to coworkers and supervisors
• Allow the presence of a support animal
• Reinforce peer supports

Attendance Issues

• Provide flexible leave for health problems
• Provide a self-paced work load and flexible hours
• Allow employee to work from home
• Provide part-time work schedule
• Allow the employee to make up time missed

Issues of Change

• Recognize that a change in the office environment or of supervisors may be difficult for a person with bipolar disorder
• Maintain open channels of communications between the employee and the new and old supervisor in order to ensure an effective transition
• Provide weekly or monthly meetings with the employee to discuss workplace issues and production level

 

[David Baxter PhD]

Part V: What If I Can?t Work? Protecting Your Rights

Bipolar Disorder on the Job Part V: What If I Can?t Work? Protecting Your Rights
By Candida Fink, MD, PsychCentral Blogs
January 5, 2010

An ?occupational hazard? of bipolar disorder is that it can trigger snap decisions, especially in the midst of a major manic or depressive episode. The illness can limit your foresight. You can?t work or foresee a time in the near future when you?ll be able to return to work, so you decide to quit, resign, or take early retirement.

These options are certainly acceptable if you?re in a position to take advantage of them and are making the decision in a state of sound mind and judgment. If you?re not, however, making a snap decision to quit can seriously jeopardize your rights as an employee and your future prospects. Before you hand in that letter of resignation, consider what you have to gain and lose. Here are some suggestions on how to evaluate your situation:

• Take as much time as you need to feel better before making a final decision. Your employer is probably not going to fire you when you?re on medical leave under a doctor?s care, and if she does, you have good grounds for a lawsuit.
• Take a sheet of paper and divide it in half. List the pros on the left and the cons on the right. Spend some time reviewing the pros and cons, so you clearly understand what?s at stake.
• Discuss your options with family members, friends, and associates you trust the most.
• Discuss your options with your doctor and therapist.
• If you have a union at work, meet with your union representative to discuss your options and possible consequences of resigning. A union rep is likely to have more experience in this area and can clearly explain what you stand to gain and lose if you resign. He or she may also have knowledge of lateral job positions that more effectively support mental health needs. Likewise, you may be able to access such information from HR (human resources) or EAP (employee assistant program) professionals at your workplace.
• When stable, work with an occupational therapist, psychiatric rehab professional and/or career counselor to conduct a job search that identifies career options which match your health sustaining requirements with work interests.

We?re not telling you to keep plugging away at a job that?s making you miserable, but we would hate to see people quit (especially when they?re not feeling well) and then regret the decision later when it?s possibly too late to do anything about it.

If you?re unable to work temporarily or permanently and need some information about filing for disability, check out our post, Do You Qualify for Social Security Disability Pay?

Additional Resources
Looking for even more information about managing bipolar or other psychiatric conditions on the job? Laurel Cargill Radley, MS, OTR, Associate Director of Professional Affairs and Heather R. Huhman, Media Relations Manager of the American Occupational Therapy Association recommend the following online resources:

• Living Well with a Psychiatric Disability in Work and School from Boston University?s Center for Psychiatric Rehabilitation
• Working in the Dark: Depression in the Workplace. Podcast from DepressionIsReal.org. Fawn Fitter, author of Working in the Dark: Keeping Your Job While Dealing With Depression, speaks to guest host Terrie Williams about the incidence of depression in the workplace and how it can be managed.
• Links to Protection and Advocacy Organization Websites from SAMHSA?S National Mental Health Information Center.