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Achieving reasonable accommodation for workers with psychiatric disabilities: understanding the employer's perspective.


The employment provisions of ADA Ada, city, United States
Ada (ā`ə), city (1990 pop. 15,820), seat of Pontotoc co., S central Okla.; inc. 1904. It is a large cattle market and the center of a rich oil and ranch area.
 have now been in effect for almost 3 years. Among the many important aspects of the law for workers with psychiatric disabilities is the requirement that employers provide reasonable accommodation Reasonable accommodation is a legal term used in Canada, which is the legal obligation to modify a law or a norm when it is contrary to fundamental rights stipulated in Canadian Charter of Rights and Freedoms. .

Although the ADA's wording on reasonable accommodation closely follows the regulations for Section 504 of the Rehabilitation rehabilitation: see physical therapy.  Act of 1973, the new law has a much broader reach. All employers with 15 or more workers are now covered. Many employers--particularly small businesses--have never previously been subject to laws prohibiting discrimination on the basis of disability. They may be unclear about the extent of their obligations or apprehensive about the potential impact of the law on the operation of the business.

Employers are particularly concerned about how to accommodate workers with psychiatric disabilities. This is often identified as one of the more challenging aspects of ADA implementation. Statistics show that 11 percent of claims under Title I to date nationally have been filed by people identifying themselves as having emotional or psychiatric impairments, comprising the third leading category of claimants.(1) Although the situation has improved in recent years, technical assistance materials on reasonable accommodations reasonable accommodations A standard of providing for a worker's or customer's needs, as mandated by the ADA, which requires that a business make appropriate changes in the environment to accommodate those with mental or physical disabilities as long as such  have historically offered little guidance for employers in this area, focusing instead on workplace modifications for employees with mobility, hearing, or visual impairments Visual Impairment Definition

Total blindness is the inability to tell light from dark, or the total inability to see. Visual impairment or low vision is a severe reduction in vision that cannot be corrected with standard glasses or contact lenses and
.(2)

Although most workers with psychiatric disabilities will never need reasonable accommodation, rehabilitation counselors are likely to be called upon to assist those who do. Since ADA's enactment, rehabilitation counselors have been identified as a logical source of information and assistance to employers. There are several reasons: first, rehabilitation counselors are unique among human service professionals in their focus on serving people with disabilities; second, the field has always encompassed vocational issues; and finally, rehabilitation counselors are trained to perform job analyses and functional assessments, both of which are very useful in developing workplace accommodations.

Whether they consider their customers to be mental health consumers, employers, or both, rehabilitation counselors are well-positioned to assist in the development of workplace accommodations. However, those practitioners who primarily serve people with other types of disabilities may feel unprepared to assist individuals with psychiatric disabilities. Likewise, psychiatric rehabilitation Psychiatric rehabilitation, also known as Psychosocial rehabilitation, is the process of restoration of community functioning and wellbeing of an individual who has a psychiatric disability (been diagnosed with a mental disorder).  specialists may be knowledgeable about the concerns of mental health consumers but less familiar with the issues of the business workplace.

This article provides information for rehabilitation counselors to use in supporting a person with a psychiatric disability who needs and wants a workplace accommodation, but has encountered obstacles to obtaining it. The article is organized around six questions that rehabilitation counselors and their clients should consider when negotiating reasonable accommodations. Consideration of the questions will elicit an understanding of potential barriers to accommodation from the employer's perspective. Each question is followed by a discussion of relevant guidance from the ADA statute or its regulations and constructive approaches to addressing the employer's concerns. The questions were derived from the author's experience in delivering training to diverse audiences on ADA implementation for workers with psychiatric disabilities.

The strategies presented here are designed to be cooperative, rather than coercive co·er·cive  
adj.
Characterized by or inclined to coercion.



co·ercive·ly adv.
. While there are many excellent printed resources for people with disabilities on how to initiate legal action, such as filing a complaint with the U.S. Equal Employment Opportunity Commission (EEOC EEOC
abbr.
Equal Employment Opportunity Commission

EEOC n abbr (US) (= Equal Employment Opportunities Commission) → comisión que investiga discriminación racial o sexual en el empleo
)(3), advice on alternative approaches to resolving ADA disputes is less readily available. This should not be construed as an attempt to deter mental health consumers from seeking legal redress when discrimination has occurred, because there are many instances in which that is the best and most appropriate course of action. But there are also many instances where reasonable accommodations are best pursued by other means. This article offers an alternative to a more contentious rights enforcement approach. Just as it would be unethical unethical

said of conduct not conforming with professional ethics.
 for a rehabilitation counselor to discourage a mental health consumer from pursuing legal remedies A legal remedy is the means by which a court of law, usually in the exercise of civil law jurisdiction, enforces a right, imposes a penalty, or makes some other court order to impose its will. In Commonwealth common law jurisdictions and related jurisdictions (e.g.  in the face of discrimination, it is equally short-sighted to prematurely rule out more cooperative methods which might bring greater benefits to the client in the near or long term.

1. Is the employee covered by ADA? One of the first questions that rehabilitation counselors and their clients should consider is whether the employer believes that the individual requesting an accommodation is covered by ADA. People with only a superficial knowledge of ADA are often not aware that the law covers individuals with substantially limiting mental impairments. This can be true of people who run businesses; depending on the size and nature of the business, there may be dozens or even hundreds of new county, state, and federal mandates each year relevant to their industry.(4) For rehabilitation counselors, on the other hand, ADA may well be the single most significant legislation in decades. Unlike most employers--especially small businesses--they are likely to have immersed im·merse  
tr.v. im·mersed, im·mers·ing, im·mers·es
1. To cover completely in a liquid; submerge.

2. To baptize by submerging in water.

3.
 themselves in studying the implications of the law through publications, professional conferences, and the day-to-day practice of their trade.

If an employer is not aware that the ADA definition of disability includes individuals with mental impairments, it may be helpful to offer written information, such as the EEOC free booklet, The Americans with Disabilities Act Americans with Disabilities Act, U.S. civil-rights law, enacted 1990, that forbids discrimination of various sorts against persons with physical or mental handicaps. : Your Responsibilities as an Employer.(5) Cornell University's Program on Employment and Disability has also published a useful four--page brochure, Employing and Accommodating Workers with Psychiatric Disabilities, which offers a basic introduction to the topic.(6)

Difficulties also arise from a difference of opinion between the employer and the employee about whether an individual's mental health problem is substantial enough to constitute a disability under the law. The ADA definition requires that the mental impairment Impairment

1. A reduction in a company's stated capital.

2. The total capital that is less than the par value of the company's capital stock.

Notes:
1. This is usually reduced because of poorly estimated losses or gains.

2.
 impose substantial limitation in the performance of one or more major life activities. People with temporary disabilities (whether physical or mental in nature) are generally not covered not covered Health care adjective Referring to a procedure, test or other health service to which a policy holder or insurance beneficiary is not entitled under the terms of the policy or payment system–eg, Medicare. Cf Covered. . However, a severe impairment that may be long-term or indefinite in duration qualifies as a disability under the law. Not everyone, then, with a mental health problem-- or even a DSM-IV DSM-IV
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). This reference book, published by the American Psychiatric Association, is the diagnostic standard for most mental health professionals in the United States.
 diagnosis--is "an individual with a disability" under the law. This has lead to confusion among employers, who are often unclear about what legally constitutes a disability resulting from a mental impairment.(7)

Based on their experience with the explosion of stress-related claims for Workers' Compensation workers' compensation, payment by employers for some part of the cost of injuries, or in some cases of occupational diseases, received by employees in the course of their work.  over the past decade, some employers have become suspicious of people who claim to have a mental disorder mental disorder

Any illness with a psychological origin, manifested either in symptoms of emotional distress or in abnormal behaviour. Most mental disorders can be broadly classified as either psychoses or neuroses (see neurosis; psychosis). Psychoses (e.g.
. Recent articles in business periodicals have suggested that, as further restrictions are imposed on stress claims, there will be a trend toward increased claims under Title I of ADA.(8) The simple fact that people with psychiatric disabilites--like those with epilepsy epilepsy, a chronic disorder of cerebral function characterized by periodic convulsive seizures. There are many conditions that have epileptic seizures. Sudden discharge of excess electrical activity, which can be either generalized (involving many areas of cells in , heart disease, and diabetes, for example--do not typically appear to be disabled may lead employers to question accommodation requests and/or to ask for verification of the disability.

Rehabilitation counselors may not be aware that ADA gives employers the right to request written documentation of an employee's disability when he or she requests an accommodation. In fact, EEOC's ADA technical assistance manual indicates that rehabilitation counselors may be among those called upon to furnish the documentation.(9) When providing such reports, rehabilitation counselors should keep in mind that the objective is to confirm that the need for accommodation stems from a disability-related functional limitation: there is no provision permitting the employer to obtain, for example, a complete psychiatric history psychiatric history A person's mental profile, which includes information about chief complaint, present illness, psychological adjustments made before onset of disease, individual and family Hx of psychiatric or mental disorders, and an early developmental Hx  or a treatment plan. Therefore, the information released should be restricted only to that needed to substantiate To establish the existence or truth of a particular fact through the use of competent evidence; to verify.

For example, an Eyewitness might be called by a party to a lawsuit to substantiate that party's testimony.
 the functional limitation. Of course, rehabilitation counselors should follow standard procedures for obtaining written consent from the client for the release of information to a third party.

Ironically, because of an employee's excellent performance on the job an employer may not be convinced that the worker requesting an accommodation actually has a disability. Some people with psychiatric disabilities summon TO SUMMON, practice. The act by which a defendant is notified by a competent officer, that an action has been instituted against him, and that he is required to answer to it at a time and place named.  vast amounts of energy to perform well from 9 to 5, only to return home exhausted. They may spend their evenings or weekends recuperating, even hospitalized, but still maintain the appearance of effortless ef·fort·less  
adj.
Calling for, requiring, or showing little or no effort. See Synonyms at easy.



effort·less·ly adv.
 excellence in the workplace. When they request an accommodation, their supervisors may be surprised, noting that they don't seem disabled. If the mental health consumer's own statements are not sufficient to convince the employer that he/she has a disability, the worker may need to obtain a brief, written statement from a rehabilitation counselor or other health professional substantiating sub·stan·ti·ate  
tr.v. sub·stan·ti·at·ed, sub·stan·ti·at·ing, sub·stan·ti·ates
1. To support with proof or evidence; verify: substantiate an accusation. See Synonyms at confirm.
 the need for the accommodation.

2. Has an effective accommodation been identified? Another potential obstacle to achieving accommodation is the identification of an effective workplace modification. Employers are often uncertain about how to develop accommodations for people with psychiatric disabilities. For example, a recent article in The Wall Street Journal stated, "...accommodating the mentally ill isn't simple. It's one thing to provide for someone in a wheelchair, but quite another to manage an employee with mood swings, phobias Phobias Definition

A phobia is an intense but unrealistic fear that can interfere with the ability to socialize, work, or go about everyday life, brought on by an object, event or situation.
, or trouble dealing with others."(10) There is convincing evidence that Americans, in general, are less comfortable dealing with people with mental illness in any context than they are in meeting people with other types of disabilities.(11) The development of accommodations is also complicated by the fact that changes are often needed in the intangible aspects of the workplace, such as schedules, work assignments, or supervisory methods. But changes to the physical environment may also be requested (such as the positioning of furniture, the location of an office, or the purchase of specialized equipment).

Companies have traditionally relied upon physicians for advice about work-related medical problems, and may turn to them for recommendations about accommodations. However, physicians--even psychiatrists--are not necessarily well-prepared to propose workplace accommodations for people with psychiatric disabilities, unless they have specialized in this area. Physicians are likely to recommend a course of action based solely on the individual's clinical symptoms, without assessing the client's skills and abilities, reviewing the job description, or visiting the worksite. All too often, no one involved has asked the one person who may be most qualified to propose an effective accommodation: the worker with the disability.

Rehabilitation counselors are uniquely qualified to assist in identifying effective accommodations. Their education prepares them to compare job demands with workers' abilities. In addition, the rehabilitation literature offers a plentiful supply of useful resource materials. For example, the continuing education continuing education: see adult education.
continuing education
 or adult education

Any form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904).
 home-study course offered by Directions in Rehabilitation Counseling rehabilitation counseling,
n counseling started in the United States in 1920 to assist individuals disabled by industrial accidents; originally included physical, psychologic, and occupational training; expanded over the next 70 years and laid the
 on Understanding the ADA features a lesson on "Accommodations for Workers with Psychiatric Disabilities."(12) Rehabilitation professionals can also link employers and employees with technical assistance resources such as the Employer's Resource Center on the ADA and Workers with Psychiatric Disabilities at the Washington Business Group on Health(13) or the Job Accommodation Network.(14)

3. Does the accommodation impose an undue hardship undue hardship Social medicine A term used in the context of the ADA, in which an employer may claim that the accommodations required to comply with the ADA are financially unviable and represent an undue hardship. ? ADA requires employers to make accommodations for qualified workers with disabilities unless doing so would impose an undue hardship. The precise definition of "undue hardship" in the individual case is central to the issue of whether or not a particular accommodation must be made. Sometimes the employer perceives that the requested accommodation imposes an undue hardship while the employee does not. In fact, this is a frequent source of disagreement between the employer and employee in ADA-related disputes. Cumulative statistics on complaints filed with the EEOC since Title I's effective date document that "failure to provide reasonable accommodation" is the second most frequently cited type of discrimination (surpassed only by complaints of unlawful discharge).(15)

Rehabilitation counselors should consider the perspectives of both the employer and the employee in negotiating reasonable accommodations. For example, a person with a disability may express frustration because the employer is unwilling to make an accommodation that involves little or no immediate cash outlay. But reasonable accommodations for workers with psychiatric disabilities often involve changes in "the way things are customarily done."(16) Change, in most organizations, is very difficult for reasons having little to do with direct financial cost. It may be easier for a supervisor to secure a purchase order for the acquisition of assistive technology Hardware and software that help people who are physically impaired. Often called "accessibility options" when referring to enhancements for using the computer, the entire field of assistive technology is quite vast and even includes ramp and doorway construction in buildings to support  than to modify established practices. When an employer is unwilling to make a needed accommodation, consider the effect of the proposed change on the productivity of the employee's work group, department, or division. Although beneficial for the rehabilitation client, a proposed accommodation might cause substantial disruption to others in the workplace. The rehabilitation counselor can help the worker with a disability generate additional options that will be effective for him or her while also minimizing any negative effect on overall workplace productivity. This is consistent with the process for developing accommodations detailed in the Title I regulations, which specify that the employer has "the ultimate discretion to choose between effective accommodations, and may choose the less expensive accommodation or the accommodation that is easier...to provide."(17) By increasing the number of options, rehabilitation counselors can strengthen the possibility of securing a reasonable accommodation.

While the regulatory definition of undue hardship includes the impact of the accommodation on the ability of other employees to perform their duties,(18) it specifically excludes consideration of disruption due to prejudice.(19) Similarly, the negative impact of an accommodation on the morale of other employees does not constitute undue hardship.(20) This is a particularly significant issue for workers with psychiatric disabilities, since prejudice against them is so common and since so often the workplace modifications they request are attractive to other employees. Because their disabilities are not typically apparent, coworkers sometimes presume that people with psychiatric disabilities are feigning illness in order to gain "special treatment." A recent article in the magazine of the Society for Human Resource Management This article or section is written like an .
Please help [ rewrite this article] from a neutral point of view.
Mark blatant advertising for , using .
 commented that "Workplace attitudes are the most common barriers to accommodating employees with mental illness. The accommodations necessary for these disabilities have a larger impact on coworkers than accommodations for other types of disabilities and can cause coworker co·work·er or co-work·er  
n.
One who works with another; a fellow worker.
 resentment." The authors suggest that educating coworkers about mental illness may lead them to be more "flexible about their own role in job sharing job sharing
Noun

an arrangement by which a job is shared by two part-time workers

job sharing job nJobsharing nt, Arbeitsplatzteilung f 
 and other accommodations"(21) for workers with psychiatric disabilities.

In the end, ADA requires employers to bear some expense or disruption in order to provide equal employment opportunities to people with disabilities. But they do not have to incur undue hardship, even if the worker with a disability requires the accommodation in order to effectively perform the essential functions of the job. Rehabilitation counselors can help negotiate a win--win situation, giving both the employer and employee something they need and want.

4. Will other employees be informed about the accommodation? If so, how? In ADA training sessions, employers frequently ask for advice on how to handle a confidential request for an accommodation. If an employee with a psychiatric disability has requested an accommodation that can be implemented without involving coworkers and is not otherwise apparent to others in the workplace, the employer can simply honor the request for confidentiality. However, in certain situations it is inevitable that others will become aware of the change. For example, if it is unusual for an entry--level employee to be assigned an enclosed en·close   also in·close
tr.v. en·closed, en·clos·ing, en·clos·es
1. To surround on all sides; close in.

2. To fence in so as to prevent common use: enclosed the pasture.
 office, coworkers are likely to inquire about why an employee was shown this apparent favoritism. Similarly, if a worker with a psychiatric disability requests a flexible schedule, this may impose certain demands on other workers to cover his or her duties. If others are not aware that the employee requesting the accommodation has a disability, the supervisor might well be uncertain about how to proceed.

There is little guidance for employers in this area. ADA specifies that information obtained from an employee's medical examination or inquiry must be kept in a confidential medical record separate from general personnel files.(22) However, the law does provide for the notification of managers and supervisors about any restrictions on the employee's duties and for safety personnel to be notified if emergency treatment is likely to be required.(23) These provisions imply that the employer should, in general, respect the employee's confidentiality, but they do not attempt to address the nuances of workplace relationships.

From a practical perspective, when a worker with a non--apparent disability who also requests confidentiality receives an accommodation that others can observe, some negative repercussions repercussions nplrépercussions fpl

repercussions nplAuswirkungen pl 
 are probably unavoidable. Imagine a situation where other employees inquire about the reason for a change and the supervisor is able to offer no comment. Whatever explanation he or she gives--or does not give--is open to misinterpretation in some way, even if it is only an uninformative un·in·for·ma·tive  
adj.
Providing little or no information; not informative.



unin·for
 statement that the reason for the change is confidential and will not be discussed. It is usually helpful to reassure the inquiring inquiring,
v to draw information from a client—whether by verbal questioning or physical examination—to assess the person's state of health.
 colleague that, should they make a request for confidentiality in the future, it will receive the same respect. Nonetheless, the absence of an official explanation often leads coworkers to their own conjectures This is an incomplete list of mathematical conjectures. They are divided into four sections, according to their status in 2007.

See also:
  • Erdős conjecture, which lists conjectures of Paul Erdős and his collaborators
  • Unsolved problems in mathematics
 regarding the accommodation and the tight--lipped response of the supervisor. Some workers with psychiatric disabilities report that the backlash from the "rumor mill" has been more damaging than a public announcement of their disability.

When the accommodation is clearly apparent to other workers, the person with a disability may choose to discuss with his or her supervisor how inquiries should be handled. They may jointly decide, for example, that a supervisor's statement that the change was made on the basis of a medical condition is appropriate with no further comment. Alternatively, the supervisor could refer all inquiries to the worker himself or herself. A somewhat more proactive approach, chosen by some rehabilitation clients, is to acquire permission from the supervisor to address a staff meeting at which the worker with a disability describes the arrangement and the reasons for it in his or her own words. In this way, the implementation of an accommodation can become an opportunity to educate people in the work environment about the personal experience of mental illness and about ADA. Since anyone can become disabled at any time, this should be of interest to all employees. As one advocate commented, "The ADA provides an opportunity for employers to offer disability awareness training to all workers. This type of training could actually prevent jealousy or antagonism antagonism /an·tag·o·nism/ (an-tag´o-nizm) opposition or contrariety between similar things, as between muscles, medicines, or organisms; cf. antibiosis.

an·tag·o·nism
n.
 from erupting e·rupt  
v. e·rupt·ed, e·rupt·ing, e·rupts

v.intr.
1. To emerge violently from restraint or limits; explode: My neighbor erupted in anger over the noise.

2.
 while de-mystifying important issues of people with disabilities. The larger effect of such training can be the reduction of stigma in the larger community."(24)

Rehabilitation counselors should know that some employers fear that making one accommodation will unleash an avalanche avalanche, rapidly descending large mass of snow, ice, soil, rock, or mixtures of these materials, sliding or falling in response to the force of gravity. Avalanches, which are natural forms of erosion and often seasonal, are usually classified by their content such  of requests by other workers that cannot be approved. This is more of an issue if the worker with a disability has requested complete confidentiality. If the person with a disability agrees that the supervisor may attribute the accommodation to a medical condition or disability, this becomes an excellent opportunity to reinforce the company's policy on making accommodations for people with disabilities. Regardless of how uncomfortable this situation is for the employer, however, he or she must make reasonable accommodations for qualified individuals with disabilities, and respect the employee's confidentiality in doing so. Given the potential consequences, decisions about whether or not to disclose in the workplace, what to say, when, and to whom, should always be made by the individual with a disability.(25)

5. Does the supervisor have the authority to make the accommodation? A supervisor who appears unwilling to make a needed accommodation may actually lack the authority to make such a change. The approval process may be very time-consuming and the supervisor may be reluctant to undertake it. For example, the proposed change may conflict with the terms of a collective bargaining agreement The contractual agreement between an employer and a Labor Union that governs wages, hours, and working conditions for employees and which can be enforced against both the employer and the union for failure to comply with its terms. . Employers have been given little guidance in this area; the Appendix to the Title I regulations indicates that the terms of a collective bargaining agreement "may be relevant" but apparently not determinative to the assessment of undue hardship.(26) Interestingly, both the employer and the union are generally covered by ADA.

If the supervisor does not appear to have the authority to make a proposed accommodation, it may be helpful to involve other relevant contacts from within the organization, such as the Employee Assistance Program, or the Human Resources The fancy word for "people." The human resources department within an organization, years ago known as the "personnel department," manages the administrative aspects of the employees.  Department. More and more large and medium-sized companies are also designating Ombudsmen(27) [sic] who can help mediate MEDIATE, POWERS. Those incident to primary powers, given by a principal to his agent. For example, the general authority given to collect, receive and pay debts due by or to the principal is a primary power.  employee requests and complaints; they may be able to recommend effective approaches to achieving reasonable accommodations within the company's unique culture and structure. They may also act as an internal advocate, working with the supervisor to accommodate the needs of the employee with a disability. Corporate disability benefits managers may also be able to intervene, particularly if the employee is receiving short-or long-term disability benefits and an accommodation could assist him or her to return to work.

The company as a whole is responsible for making accommodations for qualified employees unless doing so would impose undue hardship. When trying to arrange accommodations, it is important to intervene at the right level in the organization (i.e., with someone who has the authority to make the change). Depending on the client's preferences, the role of the rehabilitation professional may be either to support him or her in this task or to communicate directly with the supervisor or other employer representative.

6. Is there a fear factor about employing people with psychiatric disabilities? A significant but rarely discussed concern among employers in the hiring and accommodation of people with psychiatric disabilities is the perceived relationship between violence and mental illness. When negotiating an accommodation, it is important to realize that the fear of workplace violence may undermine the process.

Many employers are deeply troubled by the recent increase in the rate of violent crime in the workplace. The U.S. Department of Labor now compiles statistics on both fatal and nonfatal violent incidents in the workplace. They estimate that approximately 1,100 people are victims of homicide on the job each year, while another 22,000 are seriously injured in·jure  
tr.v. in·jured, in·jur·ing, in·jures
1. To cause physical harm to; hurt.

2. To cause damage to; impair.

3.
 by acts of violence in the workplace.(28) Employers are required by law to maintain a safe workplace, and face inestimable in·es·ti·ma·ble  
adj.
1. Impossible to estimate or compute: inestimable damage. See Synonyms at incalculable.

2.
 liability if found to have failed to do so, whether the perpetrator A term commonly used by law enforcement officers to designate a person who actually commits a crime.  was formerly a model employee or an individual never before associated with the workplace.

It is an unfortunate fact that efforts to explain and control workplace violence often reflect a tendency to automatically attribute antisocial antisocial /an·ti·so·cial/ (-so´sh'l)
1. denoting behavior that violates the rights of others, societal mores, or the law.

2. denoting the specific personality traits seen in antisocial personality disorder.
 and criminal behavior to people with psychiatric disabilities. For example, a recent text on the prevention of violence in the workplace warned employers to be alert to 10 risk factors associated with individuals who become violent, including psychosis psychosis (sīkō`sĭs), in psychiatry, a broad category of mental disorder encompassing the most serious emotional disturbances, often rendering the individual incapable of staying in contact with reality. , depression, and personality disorders Personality Disorders Definition

Personality disorders are a group of mental disturbances defined by the fourth edition, text revision (2000) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
.(29)

In fact, the relationship between mental illness and violence is poorly understood. For years, mental health advocates insisted that people with mental illness are no more likely to become violent than any other person. More recent research findings appear to contradict con·tra·dict  
v. con·tra·dict·ed, con·tra·dict·ing, con·tra·dicts

v.tr.
1. To assert or express the opposite of (a statement).

2. To deny the statement of. See Synonyms at deny.
 this position. A recent survey of a broad range of epidemiological studies An Epidemiological study is a statistical study on human populations, which attempts to link human health effects to a specified cause.  found that anyone experiencing active psychotic symptoms psychotic symptom Psychiatry A Sx representing an acute mental decompensation–eg, delusions, hallucinations, disorganized speech or behavior, or catatonic behavior. See Pain.  was at increased risk of committing violent acts, whether or not they had any previous history of psychiatric treatment. This study concluded, however, that there was only an indirect relationship between mental illness and violence to the extent that people with a history of mental disorders

Main article: Mental disorder
The history of mental disorders have long been a process of trial and error guided by public attitudes and medical theory with each society developing its own responses.
 are more likely to experience active psychotic symptoms in the future, and it found much stronger correlations between violence and other factors, such as alcohol or other drug abuse. The article also refuted the popular conception that most people with mental illness are dangerous, concluding that, "None of the data give any support to the sensationalized caricature caricature, a satirical drawing, plastic representation, or description which, through exaggeration of natural features, makes its subject appear ridiculous.  of the mentally disordered served up by the media [or] the shunning of former patients by employers..."(30) Unfortunately, such findings are not widely disseminated and are easily overwhelmed o·ver·whelm  
tr.v. o·ver·whelmed, o·ver·whelm·ing, o·ver·whelms
1. To surge over and submerge; engulf: waves overwhelming the rocky shoreline.

2.
a.
 by the daily barrage from the news and entertainment industry linking violence and mental illness. This widespread stigma undoubtedly leads to considerable employment discrimination, even among some employers who make a good faith effort to comply with ADA overall. As an attorney specializing in employment law recently commented, "There is a certain fear factor about the mentally ill."(31)

Once a causal relationship is assumed between mental illness and violence, the employer may choose to risk an ADA lawsuit by refusing to hire, retain, or accommodate someone known to be mentally unstable rather than to risk workplace violence. Of course, even if an employer could avoid hiring anyone who had ever received psychiatric treatment, the risk of on-the-job violence would not be removed. And the liability associated with violating ADA can be substantial, including compensatory and punitive damages Monetary compensation awarded to an injured party that goes beyond that which is necessary to compensate the individual for losses and that is intended to punish the wrongdoer. .

For example, a school board in Oklahoma fired a speech pathologist when they learned that her recent hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun)
1. the placing of a patient in a hospital for treatment.

2. the term of confinement in a hospital.
 was due not to cancer but rather to an acute episode of bipolar disorder bipolar disorder, formerly manic-depressive disorder or manic-depression, severe mental disorder involving manic episodes that are usually accompanied by episodes of depression.  that had led her to believe she had cancer. Her job performance was satisfactory, as evidenced by the school's renewal of her contract. Two physicians certified that she was ready to return to work and was not a danger to herself or anyone else. She had never shown any tendencies toward violence. Nevertheless, the school board feared that she was dangerous and terminated her contract. An attorney representing the school district justified her dismissal: "What position would the school district have been in if we let her go back to work and some of those students were injured or killed because of something she had done?" The teacher has filed a complaint under Title I.(32)

The subject of workplace violence is inflammatory, controversial and little understood. Employers certainly need to provide a safe working environment. Unfortunately, some employers attempt to do this by keeping those people known to have mental illness out of the work force. Through its "direct threat" provision, ADA does provide employers with the right to disqualify To deprive of eligibility or render unfit; to disable or incapacitate.

To be disqualified is to be stripped of legal capacity. A wife would be disqualified as a juror in her husband's trial for murder due to the nature of their relationship.
 from employment anyone who actually poses a significant risk of substantial harm in the workplace.(33) In this context, however, ADA's broader aim is to eliminate employment discrimination that is based on subjective impressions of the connection between mental illness with violence by requiring employers who use this provision to have objective evidence that the particular individual in question poses a significant risk of substantial harm to him/herself or others.(34) Rehabilitation counselors should be aware of the fear factor and actively counter misinformation mis·in·form  
tr.v. mis·in·formed, mis·in·form·ing, mis·in·forms
To provide with incorrect information.



mis
. There are a number of approaches that can be used to counter it, including distributing written literature about mental illness, developing and delivering disability awareness training programs, and supporting the sharing of personal testimonials by people with psychiatric disabilities.

Conclusion

The response of most employers to ADA is a constructive appreciation for its overall goals and thoughtful efforts at compliance. The majority of companies are trying to do "the right thing." Some have even made the generation of employment opportunities for people with disabilities part of their mission. They have discovered that flexibility in accommodating the needs of the entire work force is a cost-effective way to do business. In these work settings, people with disabilities may secure the modifications they need without ever having them labelled as "reasonable accommodations."

But in other workplaces, any request for accommodation--even those that do not appear to impose undue hardship--may be denied. In a small number of cases, the employer may intentionally be evading the law. Fortunately, it appears that such instances of intentional discrimination are rare. There are some cases where the requested accommodation may actually impose an undue hardship and may therefore not be required. In most cases, however, some mutually satisfactory arrangement can probably be negotiated. Doing so requires that rehabilitation counselors and their clients uncover employer objections and concerns that may be unspoken.

In their classic text on principled prin·ci·pled  
adj.
Based on, marked by, or manifesting principle: a principled decision; a highly principled person.
 negotiation, Getting to Yes: Negotiating Agreement Without Giving In a falling inwards; a collapse.

See also: Giving
, the authors explain why it is so necessary to become educated about the perspective of the other party:

"The ability to see the situation as the other side sees it, as difficult as it may be, is one of the most important skills a negotiator can possess. It is not enough to know that they see things differently. If you want to influence them, you also need to understand empathetically em·pa·thet·ic  
adj.
Empathic.



empa·theti·cal·ly adv.
 the power of their point of view and to feel the emotional force with which they believe in it...be prepared to withhold with·hold  
v. with·held , with·hold·ing, with·holds

v.tr.
1. To keep in check; restrain.

2. To refrain from giving, granting, or permitting. See Synonyms at keep.

3.
 judgement for a while as you "try on" their views. They may well believe that their views are "right" as strongly as you believe yours are."(35)

This article has investigated a number of reasons why employers might be hesitant to make accommodations and proposed steps to respond to their concerns. The questions considered here may help prepare rehabilitation counselors to support or participate in the negotiation of reasonable workplace accommodations for people with psychiatric disabilities. More people with disabilities will achieve their rights under ADA by exploring a variety of approaches to securing them.

Notes

(1.)U.S. Equal Employment Opportunity Commission, Office of Program Operations, "Cumulative ADA Charge Data for July 26, 1992-December 31, 1994 Reporting Period," January 1995.

(2.)Mancuso, L. (1990). Reasonable Accommodation for Workers with Psychiatric Disabilities. Psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects.

psy·cho·so·cial
adj.
Involving aspects of both social and psychological behavior.
 Rehabilitation Journal, 14(2), 3-19.

(3.)Two publications by the EEOC may be useful: a booklet entitled en·ti·tle  
tr.v. en·ti·tled, en·ti·tling, en·ti·tles
1. To give a name or title to.

2. To furnish with a right or claim to something:
, The ADA: Your Employment Rights as an Individual with a Disability, or the more comprehensive Technical Assistance Manual on the Employment Provisions (Title I) of the ADA. Each are available from the EEOC Publications Information Center (Telephone: 1-800-669-3362). Also, an excellent 40-page booklet entitled, Mental Health Consumers in the Work Force: How the ADA Protects You Against Employment Discrimination, is available from the Bazelon Center for Mental Health Law The Bazelon Center for Mental Health Law is a national legal-advocacy organization representing people with mental disabilities. Originally known as The Mental Health Law Project , 1101 15th Street NW, Suite 1212, Washington, DC 20005.

(4.)Keep in mind that employers may need to comply not only with ADA but also with Title V of the Rehabilitation Act of 1973 or state laws with similar nondiscrimination non·dis·crim·i·na·tion  
n.
1. Absence of discrimination.

2. The practice or policy of refraining from discrimination.



non
 provisions which remain in effect. Similarly, the Family & Medical Leave Act (FMLA FMLA Family and Medical Leave Act of 1993
FMLA Feminist Majority Leadership Alliance
)--another statute which overlaps with yet differs from ADA--requires larger employers to provide unpaid leave to employees with "serious health conditions."

(5.)This booklet is also available from the EEOC Publications Information Center (1-800-669-3362).

(6.)To obtain the brochure, contact your Regional Disability and Business Technical Assistance Center (1-800-949-4232).

(7.)To help clarify the definition of "disability" the EEOC has issued a new section for its compliance manual, which features many examples of workers with psychiatric disabilities. The 49-page document is called Directives Transmittal Number 915.002, EEOC Compliance Manual Section 902, Definition of the Term "Disability" (issued March 14, 1995). It is available from the U.S. EEOC's Office of Communications and Legislative Affairs at (202) 663-4900.

(8.)Mackey, A. (1994). Redressing Stress Without Workers' Comp. California Lawyer.

(9.)A Technical Assistance Manual on the Employment Provisions (Title I) of the Americans with Disabilities ACt, U.S. Equal Employment Opportunity Commission, January 1992. Available from the EEOC Publication Center at 1-800-669-3362 (voice or TDD (Time Division Duplexing) A transmission method that uses only one channel for transmitting and receiving, separating them by different time slots. No guard band is used. Contrast with FDD. See also TDD/TTY.

TDD - Telecommunications Device for the Deaf
).

(10.)Harper, L. (1994, July 19). Mental-Health Law Protects Many People But Vexes Employers. Wall Street Journal, pp. A1, A5.

(11.)Taylor, H. and Wurf, N. (1991). Public Attitudes Toward People with Disabilities. Study No. 912028. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
: Louis Harris Louis Harris (born 6 January 1921) is an American opinion-polling entrepreneur, journalist, and author. He ran one of the best-known polling organizations of his time, Louis Harris and Associates (LHA) which conducted so-called Harris polls.  & Associates, Inc.

(12.)Available from Directions in Rehabilitation Counseling, 420 East 51st Street, New York, NY 10022. Telephone: 1-800-367-2550 (voice).

(13.)This project was funded by the National Institute on Disability and Rehabilitation Research National Institute on Disability and Rehabilitation Research (NIDRR) is a United States governmental institution that provides leadership and support for a comprehensive program of research related to the rehabilitation of individuals with disabilities.  to help employers comply with ADA as it applies to employees with psychiatric disabilities. For more information, call the Washington Business Group on Health at (202) 408-9320 (voice) or (202) 408-9333 (TDD).

(14.)The Job Accommodation Network, a service of the President's Committee on Employment of People with Disabilities, provides free telephone consultations on accommodating persons with disabilities in the workplace. Their telephone number is 1-800-ADA-WORK (voice/TDD).

(15.)U.S. Equal Opportunity Commission, Office of Program Operations, "Cumulative ADA Charge Data for July 26, 1992-December 31, 1994 Reporting Period," January 1995.

(16.)This is one definition of "reasonable accommodation" from the Appendix to 29 CFR CFR

See: Cost and Freight
 1630.2(o).

(17.)Appendix to 29 CFR 1630.9(a).

(18.)29 CFR 1630.2(p)(2)(v).

(19.)Appendix to 29 CFR 1630.15(d).

(20.)Appendix to 29 CFR 1630.15(d).

(21.)Waert, L.V., and Dailey-Thomas, J. (1994, March). Mental Condition Does Not Excuse Misbehavior. HRMagazine, p. 55.

(22.)42 U.S.C. 12112(c)(3)(B).

(23.)42 U.S.C. 12112(d)(3)(B)(i)&(ii).

(24.)Personal communication, L. Van Tosh, October 13, 1994.

(25.)For further discussion about deliberations by individuals with nonapparent disabilities about disclosure on the job, see Case Studies on Reasonable Accommodation for Workers with Psychiatric Disabilities by L. Mancuso, (1993), available from the Washington Business Group on Health. Telephone: (202) 408-9320 (voice) or (202) 408-9333 (TDD).

(26.)Appendix to 29 CFR 1630.15(d).

(27.)Ombudsmen Proliferate pro·lif·er·ate
v.
To grow or multiply by rapidly producing new tissue, parts, cells, or offspring.
 in the Workplace. (1992, February 19). Wall Street Journal, p. B12.

(28.)"Violence in the Workplace Comes Under Closer Scrutiny," Issues in Labor Statistics, August 1994, Bureau of Labor Statistics Bureau of Labor Statistics (BLS)

A research agency of the U.S. Department of Labor; it compiles statistics on hours of work, average hourly earnings, employment and unemployment, consumer prices and many other variables.
, U.S. Department of Labor.

(29.)Baron, S.A. (1993). Violence in the Workplace: A Prevention and Management Guide for Businesses. Ventura, CA: Pathfinder pathfinder /path·find·er/ (path´find?er)
1. an instrument for locating urethral strictures.

2. a dental instrument for tracing the course of root canals.


path·find·er
n.
 Publishing of California.

(30.)Monahan, J. (1992). Mental Disorder and Violent Behavior: Perceptions and Evidence. American Psychologists The American Psychologist is the official journal of the American Psychological Association. It contains archival documents and articles covering current issues in psychology, the science and practice of psychology, and psychology's contribution to public policy.  47(4), p. 519.

(31.)Comment by Attorney Michael Lotito as quoted in Woolse, C. (1994, June 27). Employers unsure of liability exposure from bias allegations by mentally disabled mentally disabled See Cognitively impaired. . Business Insurance, pp. 3-6.

(32.)Harper, L. (1994, July 19). Mental-Health Law Protects Many People But Vexes Employers. Wall Street Journal, pp. A1, A5.

(33.)29 CFR [sections]1630.2(r).

(34.)29 CFR [sections]1630.2(r).

(35.)Fisher, R., Ury, W., and Patton, B. (1991). Getting to YES: Negotiating Agreement without Giving In--2nd Edition. New York: Penguin Books Penguin Books is a British publisher founded in 1935 by Allen Lane. Lane's idea was to provide quality writing cheaply, for the same price as a pack of cigarettes. He also wanted them to be sold not only in bookshops but in railway stations, general stores and corner shops. , p. 23.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Author:Mancuso, Laura L.
Publication:American Rehabilitation
Date:Mar 22, 1995
Words:5568
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