Disclosure Management When Returning to Work After a Leave of Absence Due to Mental Illness

The decision to disclose or not disclose a diagnosis of mental illness is not dichotomous, but should be seen as a continuum with many possible gradations. It is complex and influenced by a variety of factors (e.g., personal experiences and setting), making it a highly individual decision, and therefore an important one, especially in the context of employment. The current situation in the job market, the individual workplace, personal vulnerability to stigma, and the employer may all affect this decision as well as the consequences that may arise from it.

Disadvantages of Disclosure at the Workplace

Stigma and discrimination are significant obstacles to disclosure of mental illness at the workplace. Research has shown that employees and persons seeking employment may anticipate or experience discrimination when they disclose a diagnosis of mental illness to their employer or prospective employer. With regard to job applicants, disclosure can lead to a reduced chance of being employed (1). For employees, the decision to disclose involves the fear of being treated differently or unfairly, losing credibility in the eyes of supervisors and colleagues, rejection, and becoming a target for gossip (2). The potential for discrimination in promotion opportunities (3) and the fear of negative effects on one’s career in general are additional reasons not to disclose (4, 5).

Disclosure in the Supported Employment Context

To date, most research in this area has focused on persons seeking employment, especially in the context of supported employment and vocational rehabilitation programs. In the intervention study Conceal or ReveAL (CORAL) (6), for example, researchers developed a decision aid to assist prospective employees with mental illness in the decision-making process. The tool encompasses the pros and cons of disclosure, personal needs and values, as well as the topics of what to disclose, when, and to whom. It highlights the multifaceted character of the choice to disclose or not disclose. The Plan for Managing Personal Information intervention (7) draws attention to disclosure preferences and encourages discussion of disclosure strategies, including not only what information to share but also helpful language and ways to disclose.

Challenges for Employees With Mental Illness

Little research has been done with respect to persons who are already employed but have taken a leave of absence from work due to an episode of mental illness. This group, which might be even larger than the group of individuals with mental illness seeking employment, may face challenges such as dealing with involuntary disclosure when returning to the workplace. Symptoms of the illness may have been visible at the workplace. Employees with mental illness need to consider what they want to explain to colleagues and supervisors when they return to work and how. Support from a mental health professional or from peer-support groups can be beneficial in this determination. Some people in this group may face pressure to return to work as soon as possible, making full recovery before returning difficult. These employees would benefit from adjustments to reintegration that enable them to meet work demands and maintain performance. In this situation, some form of disclosure—at least to a supervisor—is likely necessary to obtain adequate workplace accommodations. Another factor that can influence the disclosure decision is strategic timing. If employees can wait until they feel confident and secure with their position among supervisors and colleagues, disclosure is more likely (2). However, employees who have been on leave from work may not have the choice of making a strategically timed disclosure because colleagues and supervisors might want to know the reasons for their absence.

Implications for Support

Taking these challenges into consideration, the question of disclosure versus nondisclosure for those returning to work can be crucial, and the possibility of complete nondisclosure might be limited. Employees with mental illness would therefore benefit from support on how to best manage disclosure of their condition. Research indicates that employees with mental health issues start from a default position of nondisclosure that is attributable to a fear of stigma (8). For individuals to move from this default position, the different options for disclosure need to be highlighted and the underlying pros and cons discussed. This approach has already been researched with regard to persons with mental illness seeking employment (6, 7). In the future, research on the effectiveness of such supportive approaches should be extended to persons with mental illness who have been able to retain competitive employment.

Support in the disclosure process should follow the approach of shared decision making, in which employees make their own decisions. They will benefit from discussing their options with a number of people: family, friends, other service users in mutual support groups (9), social workers, or mental health professionals. In this process, they can reflect on their own preferences and experiences. Because disclosure decisions are not dichotomous, the first steps should be to identify the options for managing the diagnosis of a mental illness in the workplace and to assess their advantages and disadvantages. The selected options could then be tested, for example, in role playing. In some cases, a mental health professional could also accompany the employee to the workplace to provide a greater sense of support and security.

For people with mental illness and those supporting them in their return to work, it is also important to be aware of the significant efforts that have been made in many countries to improve the position of employees with mental illness. With measures such as operational integration management in Germany and the establishment of return-to-work plans in the Netherlands, employers are becoming more committed to actively supporting employees with mental illness when they return to work after a leave of absence. However, these approaches are not always successful. This deficiency may be due to lack of knowledge and competence from the employer, making further education on this topic necessary. However, by choosing not to disclose their mental illness, employees may forego support from their employer, making smooth reintegration improbable. The degree of disclosure is an important consideration. In general, employees should be guided to disclose only what serves their successful reintegration.

Advantages of Disclosure at the Workplace

Because the potential disadvantages of disclosure are well known (e.g., risk of stigma), it should be highlighted that concealment can be a major stressor too, because it may lead to obsessive preoccupation and intrusive thoughts about the issue (10). Disclosure can eliminate the need to keep the secret of a mental illness and can be liberating. The energy that is used to hide a mental illness can be utilized to maintain performance and meet the requirements of the job (8). In an accepting, nonstigmatizing work environment, employees may feel less worried about how they are perceived, more accepted, and better able to explain absences or changes in behavior when they experience situations that hinder their ability to work (11).

For some employees, workplace accommodations might be necessary. Disclosure can therefore lead to increased understanding from colleagues and supervisors, resulting in positive job outcomes, such as assistance in carrying out work tasks, emotional support from colleagues and supervisors, as well as rearrangement of job tasks (8). In addition, antistigma interventions at the workplace can promote knowledge and supportive behavior (12). Even though stigmatization at the workplace remains an issue, managers and human resource departments seem to be open to better understanding employees with mental illness (13). However, they also tend to expect more openness from their employees regarding mental health because they consider these staff members to be in need of more support at work (5). Thus, it may not always be important for employees to state their exact diagnosis but rather to provide supervisors with the information they may need in order to make supportive adjustments. Information about work-related impairments, precise proposals on how workplace accommodations might support employees, and details about how long this support may be necessary would be helpful. This step would include, for example, an employee explaining that he or she feels easily distracted (e.g., in order to make supportive adjustments such as eschewing customer contact) rather than mentioning that he or she hears voices. Here, too, the job context plays an important role. For a police officer carrying a firearm, providing this information would be more complex than for someone with an administrative job.

Conclusions

Mental health professionals dealing with persons who are competitively employed should bear in mind that although work may be a stressor leading to episodes of mental illness, it also promotes stability and structure and gives a sense of satisfaction, responsibility, and accomplishment. Studies have shown that competitive employment is associated with improved mental health and quality of life (14). However, individuals with mental illness are also at risk of voluntary or involuntary employment termination (15). Therefore, it is important for people with mental illness who have competitive employment to obtain the support they need, including help dealing with the question of disclosure versus nondisclosure. Future research should focus on this group of individuals to identify effective and helpful measures regarding the decision-making process around disclosure when returning to work after an episode of mental illness.