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Accommodations For Workers With Psychiatric Disabilities

I think that a lot of what reasonable accommodations for people with mental illness are about, and asking for, is decent management that every worker has a right to, or should have a right to, and most management will tell you they give! But it ain't there! It ain't there. So, you start looking at the psychiatric accommodation - reasonable work time, workflow, constructive supervision.

-Joe, Vice President of Quality Management

Accommodations are generally assumed to arise out of discussions between the worker with a disability and his or her employer in which they identify the functions of the job, any limitations imposed by the worker's disability, and modifications to the work environment that might effectively mediate those limitations. The EEOC regulations specify that the employer should take into account, but is not obligated to abide by, the employee's preference within the range of effective accommodations.¹⁵ The employer is not required to provide accommodations that would pose an "undue hardship" on the operation of the business. Similarly, workers cannot be forced to accept accommodations that are neither requested nor needed. ¹⁶

In developing the employment regulations, the EEOC acknowledged that, in many cases, the needed accommodation would be obvious. This point is illustrated by the example of an employee who uses a wheelchair requesting that his or her desk be slightly elevated with blocks. For cases in which the needed accommodation is not obvious, the EEOC offers a formal, step-by-step process of determining the appropriate reasonable accommodation:

1.   Through a job analysis, the employer determines the purpose and essential functions of the job;
2.   The employer consults with the worker regarding the precise job-related limitations imposed by the individual's disability and how those limitations could be overcome with a reasonable accommodations";
3.   The employer and employee identify accommodations that would be effective;
4.   The employer, taking into account the employee's preference, selects and implements an accommodation.¹⁷

This process makes good common sense and allows for input by both the worker and the employer, while preserving the employer's authority to make needed business decisions. It assumes that both parties are involved in a discussion in which they exchange information about the job and the individual's disability, then arrive at an explicit decision regarding accommodations.

The current study examined the use of reasonable accommodations by 10 workers with psychiatric disabilities. An entirely different concept of the process of developing accommodations emerged from the interviews. The major findings were:

1.   Workers rarely had direct communication with their employers in which they discussed their psychiatric disabilities.
2.   Explicit accommodations -in which both the worker and his/her supervisor concurred on the accommodation being made - occurred in only two instances.
3.   Unilateral accommodations by the employer - in which the supervisor reported making changes in work assignments, scheduling, or other aspects of supervision due to functional limitations associated with the worker's psychiatric disability - occurred in four of the employment situations examined.
4.   Four workers described practices they have developed to compensate for or cope with their psychiatric disabilities on the job (of which the employer was unaware). One worker called them self-accommodations.
5.   Although five workers had been assisted by job coaches on site during at least part of their job tenure, participation in supported employment was rarely mentioned as a reasonable accommodation.
6.   Half of the employers (five) described adaptations made to the employee's individual work style, abilities, or preferences - not necessarily his or her psychiatric disability. These were viewed by the employer as mutually beneficial because they helped the worker be more productive. These could be called productivity accommodations rather than reasonable accommodations because they might be made to enhance the productivity of any worker, whether or not he/she has a disability.
7.   The accommodation most often cited by workers was a flexible or part-time schedule. The accommodations most often cited by employers were: 1) modifications in work assignments or other supervisory interventions and 2) flexible or part-time scheduling.
8.   Workers described some negative social and/or personal consequences from receiving reasonable accommodations in the workplace.
9.   Employers, in general, had little awareness of the ADA, and none of them appeared to be making accommodations in order to comply with the law. Rather, they tended to implement accommodations because they made good business sense.

Each of these findings will be further explained below.

FINDING #1: Workers rarely had direct communication with their employers in which they discussed their psychiatric disabilities.

As discussed earlier in the section on disclosure, workers had only rarely discussed their psychiatric disabilities directly with their employers. In five instances, an employment service provider told the employer that the worker had a disability before he or she was hired. In two instances, workers were employed as peer counselors, and the personal experience of psychiatric disabilities helped them qualify for the position. The three remaining workers had discussed their disabilities directly with their employers, although not until after they were hired. Interestingly, the latter three held the highest paying positions among those interviewed (between $11 and $33 per hour).

FINDING #2: Explicit accommodations - in which both the worker and his/her supervisor concurred on the accommodation being made - occurred in only two instances.

In contrast to the formal process for developing accommodations described in the EEOC regulations, as well as in much of the rehabilitation literature, most of the accommodations described in the interviews were generated informally or unilaterally. There were only two instances in which both the worker and the employer provided similar descriptions of the accommodations being made.

Judy is an associate editor with a large publishing company. In her five years with the company, she has had 13 psychiatric hospitalizations. Each time she has been absent for about three to four weeks. These absences, which generally occur with little or no notice, make it difficult for her to complete projects on time, particularly long-term assignments.

After the first four hospitalizations, her job was in jeopardy. Her employer offered her a contractual arrangement, in which she received short-term assignments (varying from one to six months) and was paid only for the hours worked. The length of the contract depended on the workload and how consistently she had been available. In agreeing to transfer from a salaried to a contractual basis, Judy lost many of her employee benefits. But she was able to remain employed and continue work which she performs well and enjoys.

Ben and his supervisor both indicated that he could take time off from work for disability-related reasons. His supervisor said, Allowances are made in his work schedule, you know, if he needs extra time off or if he needs to work shorter hours each day. While neither described any specific limitations on this arrangement, extra time off had been infrequently needed during Ben's nearly two years on the job."

FINDING #3: Unilateral accommodations by the employer - in which only the supervisor reported making changes in work assignments, scheduling, or other aspects of supervision due to functional limitations associated with the worker's psychiatric disability - occurred in 4 of the 10 employment situations examined.

Four employers described making accommodations because they seemed to be needed, not because the workers had specifically requested or agreed to them. In these four instances, there was no attempt to label the modification as an accommodation, to identify alternatives, or to gain the agreement of the worker that the change was needed. Rather, the accommodation was seen as within the prerogative of a supervisor in his or her responsibility for work assignments, scheduling, or setting and maintaining performance standards.

• Two supervisors reported having allowed additional time for the worker with a psychiatric disability to reach anticipated milestones in job performance. In one case, the worker's
  
  
• probationary period was extended by six months (even though personnel policies only allowed for an additional three months), and in both cases workers were given additional months to perform some essential functions independently.
  
  
• Another supervisor reported that she routinely lowers her performance expectations somewhat when her employee is experiencing heightened symptoms. She assigns other staff to fill in, saying, He's not expected to meet the standard he normally does.
  
  
• Another supervisor spoke very explicitly about modulating the flow of work to his employee with a psychiatric disability. He says, When she is in a particular situation, I don't press the things that I would at another point...I can modulate the demands and expectations on her time because I control that to a large extent.

In none of these cases was it apparent that the supervisor discussed these changes with the worker when they were being made. In this respect, such practices may be considered to conflict with the process of developing accommodations outlined by the EEOC in the employment regulations, which describes a flexible, interactive process which involves both the employer and the qualified individual with a disability.' Such changes, however, might simply be viewed as good management practices, since all workers have periods of higher or lower productivity depending on a variety of life factors. These four examples were selected because the supervisors specifically linked their action to changes they noted in the worker's productivity due to a known psychiatric disability. Keep in mind that while any employer is free to do more than is legally mandated to accommodate employees with disabilities, the ADA does not require employers to lower their production standards.¹⁹

FINDING #4: Four workers described practices they have developed to compensate for or cope with their psychiatric disabilities on the job (of which the employer was unaware). One worker called them self-accommodations.

Just as employers may be making unilateral accommodations, many workers have developed their own methods for coping with the impact of their psychiatric disabilities on their job functioning. Four workers described specific mechanisms they employ.

Joe used the term self-accommodation for the practices he's developed to cover memory problems (a side effect of taking Halcion): I tend not to lead with things in a meeting. I'll wait until somebody else puts it out and then let them confirm it. That covers your memory business. You don't put yourself [in a position] where you have to be definitively remembering something.

Linda has difficulty with stress on the job. Men she feels highly stressed, she can feel confused and have difficulty dealing with other people. She's learned to take a brief time-out to gather herself Most of the time I just walk away for about one minute and relax and get myself together.

Judy has multiple personality disorder. When she's having difficulty, her younger personalities can be hard to keep quiet. She tries hard to mask her symptoms so that, in her words, Other people [in the office] aren't having to cope with it. Occasionally she needs to let the younger personalities express themselves, rather than just trying to quiet them. Sometimes if it gets really bad, I'll stop and actually let whoever is out write down what's actually going on with them. It's in a different kind of handwriting. It's backwards and reverse. I was doing that this week Taking a piece of paper out and having them write down about how they were feeling, instead of fighting it, and then going back to work.

Rosanna related several instances in which she placed certain requests without identifying them as accommodations to her disability. At a previous job, she asked for and received a partition to reduce the distractions generated by a particularly noisy co-worker. On another occasion, she needed a quiet environment, with few distractions, to attempt a task (processing time cards) for the first time. She asked to have someone else cover her regular duties for a morning and occupied a private office. The next time she processed the time cards, she was able to do it at her own desk, as part of her normal routine. Rosanna has also learned to defuse urgent requests that would generate additional stress for her. For instance, her boss approached her on a Friday and asked her to schedule an important meeting several hours later. She asked to have it rescheduled to Monday, when she could be more attentive and better prepared.  She says, Now that was a reasonable accommodations request. If I need something, if I present it in an appropriate way, it doesn't even have to come out like a mental thing.

FINDING #5: Although five workers had been assisted by job coaches on site during at least part of their job tenure, participation in supported employment was rarely mentioned as a reasonable accommodation.

Neither the ADA statute nor its regulations attempts to delineate a comprehensive list of reasonable accommodations. Supported employment is mentioned only in the Appendix to the regulations, under the heading Not Making Reasonable Accommodation. The text indicates, The term supported employment...is not synonymous with reasonable accommodation;²⁰  however, determinations should be made on a case-by-case basis.

Five of the workers I interviewed had been assisted by a job coach at the work site for at least part of their job tenure. In three cases, the job coach was no longer involved with the employer, but could be available to the worker as needed. In the fourth instance, the job coach still visited the job site weekly. In the last case, the job coach supported several employees at the same work site and was present during all of their working hours; his salary was partially covered by the employer.

In general, the employers found the job coaches to be helpful and only expressed regret that their involvement ended too soon. However, when asked what accommodations they were providing, only one of the five employers mentioned the use of a job coach. Similarly, none of the workers identified the job coaches' involvement as an accommodation. This finding implies that while supported employment services may be helpful to employers and their workers with disabilities, they are not typically considered accommodations.

FINDING #6: Half of the employers (five) described adaptations made to the employee's individual work style, abilities, or preferences - not necessarily his or her psychiatric disability. These were viewed by the employer as mutually beneficial because they helped the worker be more productive.

Five employers described adaptations they made to the idiosyncrasies of their workers with psychiatric disabilities but also stated that they made such changes to enhance the productivity of all workers. Or they mentioned modifications that were win-win situations (i.e., that they met the special needs of a worker with a psychiatric disability, while also giving some benefit to the employer).

Steve works as a stock clerk in the shoe section of a large department store. He reported that he was very fortunate to have secured an accommodation which allows him to report to work in the afternoons, when all other stock clerks had to begin at 6 a.m. He also has a flexible schedule, which allows him to call and say he's not coming in for any reason, as long as he makes up the hours later in the same week He considered both of these exceptions as accommodations to his disability.

When asked what accommodations he was making for Steve, his supervisor said he was making none. I replied, I think, from talking to him, he perceives that he's fortunate to have the schedule he does and that was a special arrangement. The supervisor responded, No. We're very flexible with schedules for everybody. Because I myself go to school and I know how that is, working at the same time...We used to have people coming in early...to stock the floor so that we had the store stocked and ready to sell merchandise to the customers...But we just made an exception for Steve...And besides, Steve just moved, so it's sort of hard for him to come in the morning because buses don't run that early. And besides the truck, the people in receiving, don't usually have the shoes done until later in the afternoon, so it wouldn't make any sense to have him come in at 11 or 10 or even earlier because we would have nothing for him to do. So there is a lot of different stuff going on at the same time. I would call that a special, really small concession for him. Other than that, he's just the same as everybody else.

Vince's supervisor also described multiple reasons for giving him a daytime schedule. The following comments are paraphrased from my interview notes: He doesn't like to work at night, so I gave him days only. But this is really a help, not a problem, because it's harder to find people to work part-time during the days...I don't push him to do a lot of extra hours. He's always been willing to help out if I'm in a pinch, but I can see that it wears on him if he gets too many hours. You can see that he kind of reaches his limits.

Joe's previous supervisor said that he modified his supervisory style to suit each employee. He found that Joe performed best if given a clear goal and lots of flexibility in how to accomplish that goal. Then he just checked in periodically to see how Joe was progressing. He commented that he thought Joe did some of his work at home, that he might have had difficulty with the typical 8:00 to 4:00 office schedule. However, it didn't concern him because Joe consistently performed well.

The above examples illustrate situations in which mutually beneficial arrangements evolved between workers and supervisors. Perhaps some of the above modifications would be better termed Productivity accommodations since they help the worker be more productive, whether or not he or she has a psychiatric disability. It is likely that many employers make such modifications routinely for other workers as well (e.g., parents of small children, those caring for elderly parents, or employees with brief illnesses). From this perspective, making accommodations is not a new practice nor is it unique to the ADA.

Are these all examples of reasonable accommodations under the ADA? Perhaps not. And it is likely that the workers benefitted from getting the accommodations without labeling them as such. However, in each of these situations, the worker could have asked for the accommodations under the ADA- Flex-time (in Steve's case), daytime hours (in Vince's case), or the flexibility to work at home (in Joe's case) could each be considered an accommodation under the ADA. The employer's obligation to provide the accommodation would hinge on whether or not it imposed an undue hardship.

FINDING #7: The accommodation most often cited by workers was a flexible or part-time schedule. The accommodations most often cited by employers were: 1) modifications in work assignments or other supervisory interventions and 2) flexible or part-time scheduling.

Six of the ten workers named a flexible schedule as one of the accommodations received on the job. This item has consistently surfaced in anecdotal reports of reasonable accommodations helpful to workers with psychiatric disabilities. The arrangements varied from a formal policy (in Judy's situation) to an informal policy (in Bill's case). In some cases, workers took unpaid leave or made up lost work time; in other cases, they applied medical leave or did not need to record the absence at all. Several workers also stated that they routinely used medical leave for mental health days.

Six supervisors described making changes in work assignments, management style, or performance milestones. In addition to the five instances discussed in Finding #6 above (which were not explicitly linked to the worker's disabilities), Judy's supervisor made an explicit accommodation to her frequent absences. While other editors in her department might work on six or eight assignments simultaneously, Judy is given only one (usually more difficult) project at a time. This makes it easier for someone to pick up her work, or for her to still meet a deadline, if she becomes hospitalized

Five supervisors listed flexible schedules or the development of part-time positions as accommodations provided

Categories of accommodations for workers with psychiatric disabilities have emerged from discussions with mental health consumers and their employers in this study, my experience in delivering training on the ADA, and other sources as indicated below. In reviewing this list of potential accommodations, keep in mind the following: while employers and employees may negotiate virtually any workplace modification that is acceptable to both parties, employers are only required by the ADA to make accommodations that do not pose an undue hardship on the operation of their businesses.

schedule modification

• allowing more frequent breaks
  
• allowing workers to allocate their break time according to their own needs, rather than a predetermined schedule
  
• allowing workers to shift schedules earlier or later
  
• allowing workers to take a prolonged lunch break to attend a support group meeting (e.g., AA)
  
• allowing workers to use paid or unpaid leave for appointments related to their disabilities
  
• allowing an employee to work part-time temporarily (e.g., when first returning from an absence)

job modification

• arranging for job sharing
  
• reassigning tasks among workers
  
• re-assignment to a vacant position

modifications to the physical environment

• providing an enclosed office
  
• providing partitions, room dividers, or otherwise enhancing soundproofing and visual barriers between workspaces
  
• offering a reserved parking space (e.g., to workers with phobias or anxiety disorders)
  
• blocking noise (e.g., by reducing the pitch or volume of telephone rings)
  
• increasing the spatial field to allow a larger Personal space"
  
• positioning the worker as far away as possible from noisy machinery ²¹

changes in policy

• extending additional paid or unpaid leave during a hospitalization or other absence
  
• allowing additional time for workers to reach performance milestones
  
• extending the probationary period
  
• allowing an employee to make phone calls during the day to personal or professional supports
  
• providing a private space in which to make such phone calls
  
• providing a private space for employees to rest, cry, or talk with supportive co-workers²²
  
• allowing an employee to work at home
  
• allowing workers to consume fluids at their work stations throughout the work day (e.g., if needed due to medication side effects)

provision of human assistance

• allowing a job coach to come to the work site
  
• participating in meetings with the worker and his/her job coach or other employment service provider
  
• paying for part or all of the net costs of a job coach

provision of assistive technology

• providing a portable computer to enable an employee to work at home ²³ or at unusual hours²⁴
  
• providing software that allows the worker to structure time and receive prompts throughout the workday

supervisory techniques

• offering additional supervisory sessions
  
• offering additional training or instruction on new procedures or information
  
• offering information and training in the worker's preferred mode (orally, visually, written, or experiential)
  
• ensuring the supervisor is available throughout the work day
  
• reassignment to another supervisor

The following modifications are examples of proactive steps that may make the overall work environment more accommodating of people with psychiatric disabilities - and perhaps all workers:

offering specialized training to help employees advance and achieve promotions creating and advertising permanent, part-time positions modifying a job description to suit an employee's unique talents and limitations specifically stating that employees may use sick leave for physical or mental reasons training supervisors to customize their management style training supervisors to temper negative feedback by providing positive feedback simultaneously training coworkers to increase their sensitivity to the experiences of persons with disabilities assigning a co-worker to act as a buddy or mentor establishing incentives for coworkers to serve as buddies or mentors.

FINDING #8: Workers described negative social and/or personal consequences from receiving reasonable accommodations in the workplace.

Although the ADA is intended to guarantee the rights of workers with disabilities to accommodations, requesting and securing accommodations may bring unforeseen negative consequences. This may be particularly true for workers with psychiatric disabilities because the accommodations they benefit from may seem appealing to many others. For example, it is unlikely that other workers would be jealous of someone with low manual dexterity who arranged to have special handles installed at her work station. In contrast, workers with psychiatric disabilities who are allowed flexible schedules may experience antipathy or jealousy from their co-workers. This situation is especially problematic if the worker with a psychiatric disability has chosen to disclose to his or her supervisor, but not to others in the work place. When it becomes evident that a single worker is allowed to report to work at a later hour, other employees may press the supervisor for an explanation.

Some of the accommodations previously listed may involve benefits that other workers can only accrue by attaining seniority or promotions.²⁵  If the situation is not carefully handled by both the supervisor and the employee, there is obvious potential for strife. Accommodations can create conflict between workers.

Rosanna has difficulty maintaining concentration and requested a partition to reduce the distractions caused by another employee. She got the partition, although she never indicated that she needed it because of a psychiatric disability. Rosanna found it was hardly worth asking for because it created such animosity between the two of us.

For some, receiving accommodations can create a sense of indebtedness to the employer. Judy explained her feelings and contemplated whether she might have felt differently if she had a visible disability:

Judy: It's hard to be constantly on the receiving end of favors. It puts you in a very uncomfortable position because you feel more and more guilty, and more and more obligated, and more and more like you ought to be doing extra things or trying to make up to them for how kind they're being. And maybe that isn't so true with people with physical disabilities. If you're in a wheel chair and you need a ramp, you get the ramp. Maybe you can accept that without feeling you have to bend over backwards to do nice things for them afterwards. I find it hard not to feel it's a great big pain in the ass a great deal of time and that's it's very nice of them to be doing whatever they're doing for me and I should be very, very grateful and take lying down sort of whatever gets dealt out.

FINDING #9: Employers, in general, had little awareness of the ADA, and none of them appeared to be making accommodations because they feared legal consequences. Rather, they tended to implement accommodations because they made good business sense.

Each of the supervisors interviewed in this study was selected because he/she employed at least one person known to have a psychiatric disability. Further selection occurred in identifying those willing to be interviewed. I assumed that supervisors meeting both criteria would be, on average, more informed about the ADA than managers in general.

Much to my surprise, few of the employers seemed knowledgeable about the employment provisions of the ADA. Two of them were familiar with Title II (since they worked in state or local government and were leading organizational activities in those areas), and another had a rudimentary awareness of Title III. Another claimed to be familiar with Title I since it was covered in a management class at a state university. But when I pressed him for details, he said, Well, they have to have like a quota or a minimum on hiring people with disabilities or something like that. They have to make room for somebody with disabilities, no matter what. Something like that. Both of these statements are inaccurate, since the ADA neither establishes quotas nor compels employers to hire unqualified people because they have disabilities.

• When asked how they'd learned about the ADA, most supervisors stated only that they had read about it in the newspaper or seen a story on the news last summer. This was even true for one supervisor who had a mobility impairment.
  
  
• None of the supervisors reported that they were aware of any formal policy or procedure for the employment of persons with disabilities or had received any specialized training. There was one exception: one supervisor pointed to an ADA poster on the wall near his desk The corporation told all of the managers about the ADA, he said, and encourages them to hire people with disabilities whenever possible. But it's completely up to the manager whether they do or not. At another site, a department head said she was not aware of any formal policy but applied general principles of non-discrimination on any basis. She said, I can't remember seeing even a memo about the ADA.
  
  
• Another interviewee, who founded the industrial materials recovery facility where he served as vice president and general manager, was familiar with the law but had been hiring workers with disabilities long before the ADA. He said, I know for employers the laws are always changing, and it's hard for us to keep up with everything. We're concentrating so hard on making money, just so you can pay the bills, get out of the recession. You get tired of watching all the laws and how they're changing and being informed of all of them. We can't go to all the seminars that are out there."

If the supervisors' knowledge of the ADA is limited, why are they making accommodations? After discussing the accommodations they had made for their workers, I asked employers, To what extent did you make the accommodation because you were legally obligated to? None felt that they had acted in order to comply with the law. Rather they cited other reasons for making accommodations, such as:

a.   because it made good business (i.e., financial) sense,
b.   because they made such modifications for any employee who needed them,
c.   because they had come to value the worker overtime (e.g., for his/her skills or reliability) or
d.   because they had empathy for the worker's needs and considered the accommodation fair or humane.

Conclusion

Reasonable accommodations for workers with psychiatric disabilities may be made through more or less explicit arrangements. Some supervisors make modifications to the individual needs of all of their workers, including those with psychiatric disabilities. Workers, too, may develop methods of compensating for their disabilities which do not involve the employer. In the best case, accommodations are developed which are mutually beneficial.

None of the supervisors I interviewed had accessed technical assistance materials on the ADA. It appears that most managers are making decisions based on their own sense of fairness or profitability. Their knowledge of the ADA, to a significant extent, is based on media reports to the general public. One possible recommendation based on this finding is that advocacy efforts to educate employers about the ADA should include the development of materials for use by the general media, not only for distribution through professional associations or other specialized channels.

None of the employers interviewed talked about undue hardship or mentioned being asked to do something they could not. There was also little evidence that any of the employers I interviewed had made accommodations because they felt they were required to by specific provisions of the law. This surprising finding may be attributed to the preselection for this study of employers who supervised individuals with a known disability. Perhaps these employers are more progressive, on average, than others. If so, they represent the class of most highly qualified targets for job development since all of their employees are probably well-treated. The findings offer insights for securing jobs and accommodations at these types of worksites.

Questions for further investigation or research include:

• Among accommodations already being made in workplaces for employees with psychiatric disabilities, what proportion are explicit, unlabeled, or unilateral?”
  
  
• How often are employers lowering their production standards as an accommodation to a worker with a disability, even though not required by the ADA?
  
  
• What negative consequences have workers with psychiatric disabilities experienced as a result of receiving accommodations? How have they minimized or overcome these problems?
  
  
• When a formal process is needed, how can employers and employees locate rehabilitation professionals to perform job analyses and help identify effective accommodations?
  
  
• Through what channels are employers receiving information about the ADA? Through what channels are employers receiving general information about workers with psychiatric disabilities?
  
  
• In what ways do employers with good management skills make accommodations to the individual needs of each of their workers?
  
  
• To what extent are businesses incorporating ADA provisions into their personnel policies?
  
  
• What can be learned about ADA implementation from businesses that make accommodations for all of their workers?

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