It's Not in Your Head: Mental Health at Work

Last summer, the CEO of a specialty software provider in Ann Arbor, Michigan, briefly became a hero to people struggling to maintain their careers while facing mental illness.

Web developer Madalyn Parker, a web developer for Olark Live Chat, emailed several coworkers to inform them she was taking two sick days “to focus on (her) mental health.” “Hopefully I will be back next week refreshed and back to 100%,” Parker added. “I wanted to personally thank you for sending emails like this,” replied Ben Congleton, CEO of Olark, which provides chat software to help businesses communicate with customers. “Every time you do, I use it as a reminder of the importance of using sick days for mental health. … You are an example to us all, and help cut through the stigma so we can bring our whole selves to work.”

Parker posted a screengrab of the email exchange on Twitter and it went viral, accumulating more than 10,000 retweets in two weeks. Twitter users applauded Parker’s openness and Congleton’s supportive gesture and some responded with contrasting stories, in which bosses called them soft for taking time off for psychological health or deemed their reasons invalid for a sick day.

“I once called in to take a mental health day,” responded Twitter user “ms. roboto.” “My boss told me anxiety isn’t a real illness & that I needed a doc’s note.”

About one in five American adults have a mental illness of some kind, according to a 2015 survey. While most people agree that we’ve become more open about discussing behavioral health, shame and mistrust still lingers in workplaces: 41 percent of adults said they would feel uncomfortable working with someone with a serious mental illness. Disclosing a diagnosis to managers and coworkers brings up complex and sometimes competing concerns about stigma, privacy and legal protection.

David Ezell, clinical director of the Connecticut therapy group Darien Wellness, says some of his clients are stressed about guarding their mental illness at work from superiors. Some managers and bosses “will use your mental illness against you, especially in specific industries,” says Ezell. Stigma is greater in high-stress professions that require reliability and competence. “Finance, medicine — yes, medicine — and law enforcement are areas where I have had clients fearful of coming clean on their diagnoses,” he says.

“Quite frankly, I think it’s a shame we have to be having this discussion in 2017,” adds Ezell. “I am not familiar with anyone being ashamed of have a sore throat or a cancer diagnosis. Sadly, I see people ashamed of being depressed or having ADHD every day.” Employees facing a mental health problem might be inclined to keep the reasons for their sick day or the five o’clock appointment they have to keep to themselves. Others, like Madalyn Parker, might sense their workplace is affirming and supportive and be open.

Experts say disclosure should come when it’s necessary, when one has reached a point where their mental illness will interfere with work, and they should know the culture of their workplace, as well as their rights.

Your rights

The 1990 Americans with Disabilities Act dictates how businesses with 50 or more employees accommodate those with handicaps, including diagnosed mental health conditions. If you work somewhere with fewer people, there is a good chance a state or local law extends some similar protections to you, says Lawrence P. Schaefer, a Minneapolis attorney specializing in employment law. “In every state, there is a law with parallel protections,” he says. “In Minnesota, there’s a law that fills in the gap for places with one employee.”

Schaefer says that if you choose to disclose a mental health diagnosis at work to your employer, familiarize yourself with a few key rights and concepts from the ADA and state and local laws like it.

Disabled employees of all stripes have a right, under the ADA, to “reasonable accommodation.” “It has to be something an employer can provide to make it so you can meet the expectations of the position,” says Schaefer. For those with manageable mental illnesses, like moderate anxiety or depression, this often means a more flexible work schedule, to keep appointments with mental healthcare providers or to relieve some stress. It could also mean small exemptions to office rules, like permission to wear headphones and listen to music when working, if that will decrease anxiety.

“What's considered reasonable will be different to each business,” says Jill Santopietro Panall, a Boston-based HR consultant. An accommodation allowing for a few work-at-home days might be reasonable for a proofreader at a publishing house; it wouldn’t be for a security guard.

Karen (a pseudonym), a retail manager at a locally sourced goods and grocery store in the Midwest, said she can’t work an a.m. shift due to manic depression and its treatment. “Mornings, I go through a whole process,” she says. She has difficulty waking some days and her dose of Paroxetine, taken each morning, causes nausea and tiredness, which she slowly works through until mid-day.

The reasonable accommodation for which Karen asked and received was being moved to the evening shift. It was “uncomfortable” explaining her condition to her general manager, she says, particularly because she came to the realization it was necessary a few weeks after she was hired. She started working 4 p.m. to close and has been happy at the job ever since.

Schaefer notes that it’s the employer’s obligation to show that an accommodation is an “undo burden,” if the matter ever goes to court. “They would have to show why they couldn’t provide a (requested) accommodation.”

The employer is obligated to allow these accommodations without any “adverse outcome” to the employee, says Schaefer, and that can mean anything from a negative performance review to a firing, if it can be traced back to the disclosure of a mental illness. For more severe cases, the Family Medical Leave Act of 1993 protects a person’s rights to take an absence from work to resolve a mental health crisis, just as it does any other medical crisis. Like the ADA, it only pertains to workplaces of 50 or more, but some local or state laws spread protections further.

Finding allies

Before you start to identify allies, consider whether or not it is necessary, experts advise. Even if you’re the type to discuss mental illness at work out of a sense of openness or a desire to be an agent against stigmatization, disclosing a diagnosis to an employer has a whole different dimension. There are reasons to hold off until a problem is actually interfering with your work performance.

If your employer is complying with federal law, there’s no question that they will think of you differently once you disclose. They have to. It “will put them on notice that they need to approach you with some special considerations,” says Schaefer. And some employers do try to skirt laws and force out staffers because of discomfort with mental illness or out of the assumption such people are burdensome. “If they didn’t, attorneys like me wouldn’t be in business,” says Schaefer.

J. Bryan Wood, an employment law attorney in Chicago, recommends that “if your culture or relationships are more ‘buttoned up,’ keep diagnoses, conditions or prescriptions private where possible.”

As for who to tell when the time comes—your manager or a human resources representative—consider your relationship to your manager. “Think about interpersonal dynamics such as power relationships, your relationship with your boss and your organization’s culture,” says Wood. “In exercising your rights, if your boss is likely to react negatively, use HR as a buffer. But if your boss is a strong ally, talk to your boss before engaging HR.” Your manager might be helpful in carving out a plan with HR. Ultimately, these rights are yours and they do provide protection that might be vital in protecting your career. “Ask for what you need when you need it,” advises Wood. “Don’t wait until it's too late and your issues lead to poor job performance.”

Psychologist Anna Rowley, PhD, spent years as an embedded psychologist for tech giants like Yahoo, Microsoft and GoDaddy, trying to understand stress, culture and work performance. She saw one executive, who later confided that he had a mood disorder, rack up poor performance reviews. “There were times when he appeared together and could lead and communicate, but his mood changed to be combative,” she says. The man could have sought help and disclosed his diagnosis to his company. Managers might have seen his mood swings as issues that he was working to address and alleviate. Instead, he was dubbed “erratic” and “unpredictable” and eventually fired.

To disclose or not to disclose

For Robert Dean, disclosing his anxiety disorder to his employer feels like a punk rock move. “That’s something I picked up from the culture of Austin: Don’t fake it; be who you are” says Dean, a copywriter for Student Loan Genius, a financial services company that works with companies that create incentive programs to help employees pay down student loans. Dean, 36, says he has permission to work from home whenever he’s in the midst of an anxiety spike. His employers are supportive. “As long as I get my work done on time, they don’t care,” Dean says.

Others feel pressure to clam up. “I would never tell my bosses about my mental illness,” says Audrey (a pseudonym), who manages online listings and content for a real estate firm near Washington, D.C. “For two reasons: I don't believe people want to know if someone has a mental illness at work and secondly, I believe most employers would worry about mental illness affecting a person's work.”

Diagnosed with anxiety and depression, Audrey is prone to unreasonable worry. When she doesn’t hear from her husband for a few hours, she will fixate on the thought that he could be dead. She’s scheduled therapy appointments and told her bosses she was seeing a dentist.

She is worried she might be passed up for a promotion in a competitive field. “I think the stigma would say, ‘She can’t hack it,’” she says. “I think if they found one thing about you that’s not perfect, they’ll focus on that. It’s the same if you walk with a limp. If you are up against someone who doesn’t, they’ll focus on that. I don’t think that’s appropriate, but they will see that as a negative.”

Some employees had little choice but to tell their boss what’s happening. Chris, a tech employee in Eastern Pennsylvania who specializes in search engine optimization, says that two years ago he was dealing with a barrage of suicidal thoughts. He pushed himself through the workday and played video games at night, all while waves of hopelessness threatened to push him over the edge.

At a one-on-one meeting with a manager, to go over usual work obligations, he broke down. “I lost the ability to make eye contact with her,” he remembers, “and then I was crying a little bit.” It couldn’t go uncommented-upon, so he explained he was going through a major depressive episode. This manager was “always very kind and smart,” says Chris, and she listened with empathy. She let him take the rest of the day off.

Chris was frightened of losing standing at work, but even more frightened of falling further into depression. His psychiatrist suggested taking time off from work and coming to see him every day. Chris met with his manager and members of the company’s HR team to arrange medical leave. They all seemed to stick to the specifics of his rights and obligations. “They were choosing their words carefully,” he recalls.

His sabbatical was difficult but productive. “Disability is nothing like vacation,” Chris says. “I did not relax. I was anxious about my entire life and career and this was about getting a handle on that.” He returned after about a month. Most of his coworkers knew why he was gone. “I heard whispers,” he said, “but also a lot of people came up to me to offer support.”

Chris sent an email blast to his department, explaining that he had been dealing with his mental health and thanking everyone for their support. This did not go over totally smoothly. A few days later, the higher-ups sent an email informing employees that communication about sick time should only go to their managers. He’s pretty sure it was in response to his email. Still, he’s grateful to his employer. He thinks they saw the value in him being stable and healthy, both for himself and the company. “I can see the value of being more patient in a creative field where you’re engaging someone’s mind,” he says.

Rowley, the psychologist who examined internal dynamics at tech companies, says that the division between one’s workday life and mental health is a thin and eroding one. She says people are increasingly “tethered” to their work through mobile devices. They are not getting a proper break from workplace concerns and the workplace concerns are often dark and ugly. “Instability and conflict in the workplace is increasing,” she says, “Bullying and harassment are common tactics and with that come behaviors like drinking and binge-eating.” In hyper-stressed workplaces, “the traditional ways of coping don’t work anymore.” By encouraging and enabling employees to seek help, a company does itself a favor. Untreated mental illness can cause stress that gets cycled back into the workplace.

Rowley says companies should encourage and enable employees to seek help for mental illness at work—which can often involve quite a checklist: “We are expecting a lot of people to keep appointments and travel across town to use psychotherapy, to take medication, and it’s bloody hard to find therapists,” she says.

However, the idea that prioritizing mental health should be done on “personal time” and not “company time” is an antiquated one. As the line between “work life” and “personal life” dissolves and companies compete to offer cushier benefits and perks for their employees, creating a supportive work environment should be a top of mind. Employers can take proactive steps to ensure that their employees know their rights when it comes to their healthcare and ensure everyone knows they can get the support they need to stay healthy and do their best work.

Illustration by Tin Nguyen