Workplace Disclosure of Serious Mental Illness and Gainful Employment: Theory and Evidence.

ABSTRACT

BACKGROUND: This study provides the first systematic analysis of the association between workplace disclosure of serious mental illness (SMI) and the probability of gainful employment, among workers employed in regular jobs. By regular job, we mean one that pays at least minimum wage, is not set aside for persons with disabilities, and was not obtained with assistance of mental health services. By gainful employment, we mean a regular job with monthly earnings that exceed the maximum allowable earned income for receipt of Social Security Disability Insurance. AIMS: Among persons with SMI who are capable of working in regular jobs, we aim to identify (i) what individual and work-related factors are associated with the decision to disclose mental illness at work; and (ii) how the decision to disclose is related to the probability of gainful employment. METHODS: The analyses are based on a theoretical framework in which workers choose a level of disclosure to maximize utility from the benefits of employment, subject to constraints associated with mental illness-related stigma. We specify a bivariate probit regression in which the probabilities of disclosure and gainful employment are determined jointly. The model is estimated with data from a national survey of 602 workers, with schizophrenia, bipolar disorder, or major depression, who were employed in regular jobs post-onset of illness. RESULTS: The results identify individual (e.g. younger age, less self-stigma, more severe cognitive limitations) and work-related (e.g. longer job tenure, supportive firm, administrative support occupation) factors significantly associated with the probability of disclosure. The results also indicate that disclosure has a significant positive association with the probability of gainful employment, when the empirical model controls for the endogeneity of disclosure in the employment function. Other variables that have a significant positive association with gainful employment include education, job autonomy, and employment in a white-collar occupation. DISCUSSION: The data support the hypothesis that workers with SMI make the decision to disclose their condition based on the probability of a positive response from their employer, and this rational behavior is likely the reason for the strong correlation between disclosure and the probability of gainful employment. However, a limitation of the study is that our retrospective survey design cannot identify causal relationships. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Work is an important recovery goal for many workers with SMI, so the disclosure decision is likely to be a significant topic of discussion between workers and their health care providers. IMPLICATIONS FOR HEALTH POLICIES Amid the current focus on wellness in the workplace, policies aimed at reducing the stigma of mental illness at work, and promoting more tolerant and supportive workplace cultures, can improve the probability of gainful employment for workers with SMI. IMPLICATIONS FOR FURTHER RESEARCH Further research is needed to design and implement workplace interventions that minimize the monetary/nonmonetary costs of disclosure for workers with SMI in regular jobs.