Disclosure of Serious Mental Illness in the Workplace

Project: Research project

Project Details


Project Aims: The overall aim of the parent grant (R01 MH111650) is to identify how workplace disclosure of a
serious mental illness (SMI) can be managed so that disclosure is most likely to result in appropriate job
accommodations, long-term stable employment, and service engagement. The parent grant uses a mixed
methods design. We are collecting quantitative data from 1,000 persons with SMI who have worked in a
mainstream competitive job post-onset of mental illness. (We define a competitive job as one that pays at least
minimum wage, is not set aside for persons with disabilities, and was not obtained through a supported
employment program) We are also collecting qualitative data from in-depth interviews with a select subset of
our study population. The qualitative data will provide detailed evidence on individual experiences of disclosure
that have led to positive or negative work outcomes. The specific aims of the project are:
1. Identify individual, work-related, and service-related characteristics that are significantly correlated
with the decision to disclose SMI at work.
2. Examine the relation between disclosure of SMI at work and: employment outcomes (including the
probability of receiving employer-provided job accommodations) and service engagement.
3. Describe the mechanisms involved in workplace disclosure of SMI, including how differences in the
process of disclosure (what is said, when, how, and why) are associated with positive vs. negative
A 16-month administrative supplement is proposed so that we may collect data from the employer side of the
disclosure equation. Specifically, we propose to interview 200 individuals who have directly supervised a
worker with serious mental illness in a mainstream competitive job. Both quantitative and qualitative data will
be collected to understand supervisors responses to a workers disclosure of SMI; and key mechanisms that
potentially modify a supervisors response. In collecting, analyzing, and interpreting the data we will collaborate
with members of the Community Advisory Board (CAB) for the parent grant. The Board involves a wide range
of stakeholders, including a large national network that provides guidance on workplace accommodations and
disability employment issues.
The supplemental funding will not expand the currently specified aims of the study. Rather, the employer data
will enable us to make more efficient use of our current data collection strategy and study sample in addressing
the original Specific Aims. Those aims are consistent with NIMH Strategic Research Priority 4.1, namely:
Strengthen the Public Health Impact of NIMH-Supported Research through research that improves the
efficiency and effectiveness of existing mental health services. The low employment rates of persons with
SMI, [1] and the fact that they represent more than one-fourth of recipients of SSDI, [2] suggest that improving
work outcomes for this population is an urgent need. The supplemental funds will enable us to learn, directly
from employers how they respond to a workers disclosure of SMI, and what motivates their response. This
information is a first necessary step in designing employer-based interventions to support the disclosure
process in ways that lead to service engagement and positive work outcomes.
As described in the Budget, supplemental funding will be used to cover the costs of screening and
administering on-line surveys to eligible supervisors. Funds will also be used to conduct in-depth, follow-up
interviews with a targeted sample of employers, and to support a data analyst and graduate assistant.


When a person with serious mental illness (SMI, defined as schizophrenia spectrum or bipolar disorder) is hired into a competitive job (defined as one that pays at least the minimum wage and is not set aside for persons with disabilities), they face a decision regarding whether or not to disclose their mental illness at work. Disclosure is required to obtain reasonable accommodations (such as flexible schedules, or time off for medical appointments) under the Americans with Disabilities Act (ADA), but the decision to disclose is risky. Sometimes, disclosure is an empowering act that results in necessary job accommodations, as well as greater support from supervisors and coworkers. Then again, disclosure can lead to discrimination, harassment, isolation, negative stereotyping, and even job loss.
Despite the importance of the decision, there is very little evidence on disclosure of serious mental illness in the workplace. We do not know what motivates a worker to disclose, what determines the outcomes of disclosure, or how disclosure plays out in real-world employment settings. The proposed project is designed to address this critical gap in our knowledge, by gathering both quantitative and qualitative data on the process of disclosing SMI at work.
We plan to survey 1,000 persons with SMI who have worked in a competitive job after onset of mental illness. We will screen for our target population by piggybacking on a large on-going national health survey (the PULSETM). We will follow up with a telephone survey designed to capture relevant quantitative data on the factors that determine the decision to disclose (or not to disclose) SMI at work, and the impact of that decision on employment outcomes and service engagement. We will then conduct in-depth interviews with a select subset of our study population, to obtain detailed qualitative evidence on individual experiences of disclosure that have led to positive or negative outcomes, with the goal of informing best practices for disclosure decisions.
One of the primary outputs of the project will be a set of manuals on workplace disclosure of SMI, for consumers and behavioral health providers. The manuals will provide evidence, based on our results, to assist consumers and their providers in optimizing their individual decisions regarding workplace disclosure of SMI. As such, the project has tremendous potential to empower consumers to manage the disclosure process in ways that increase the likelihood of effective job accommodations and employment success
Effective start/end date7/1/174/30/21


  • HHS: National Institutes of Health (NIH): $2,303,806.00


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