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A survey of Fortune 500 corporate policies concerning the psychiatrically handicapped.


It took a very long time for the business community to realize that employing a physically disabled person may be more than an act of humanitarian good will. Despite an increased emphasis on "hiring the handicapped," there have been only scattered reports of employers' policies involving the hiring and promotion of psychiatrically handicapped persons. For the purposes of the present survey, the latter term was defined for corporate respondents as "an individual with a history of chronic mental illness, generally including at least one psychiatric hospital admission." This study was conducted to plug the gap in the applied literature by answering the question:

What is the current status of corporate policies concerning the psychiatrically handicapped?

An answer was sought by the application of scientific survey methodology to the population of Fortune 500 companies.

Literature Review

In the 1980s, the National Institute of Mental Health (NIMH) undertook a battle against the stigma of mental illness through an information campaign designed to stimulate the employment of people who have recovered from disabling mental illness (*1). This was an important development, not only for the sake of psychiatrically impaired people who want to work and cannot find a job, but also for those who are already in the work force. Logic would dictate that any reduction in the stigmatization of mental illness would be directly related to a greater willingness of employers to assist mentally ill employees with their personal problems. How important is this issue? The overall size of the mentally ill population in the United States is enormous. NIMH estimates that approximately 20 percent of Americans will develop a mental illness at some point in their lives. That translates into 50 million people. Of this group of people, more than 2 million are chronically mentally ill (2). There is also a large number of psychiatrically impaired people in the work force. The Census Bureau reports that, of the 154,565,000 people in the labor force between the ages of 16 and 64,22,514,000 of them are disabled in some way (3). Of this disabled group, 1,743,000 are impaired because of a psychiatric problem. This includes people suffering from chronic mental illness such as serious depression (434,000), mental retardation (605,000), nervous or emotional problems (640,000), and senility or Alzheimer's disease (64,000). Because of the chronic nature of their debilitating conditions, the psychiatrically impaired are likely to drop in and out of work force. In 1984, the last year for which figures were available, 289,000 of them performed some kind of work (*3). Clearly a significant number of people in the work force are functioning under the burden of a psychiatric limitation. This study is designed to asses one dimension of this important problem-- the extent to which major American Corporation have policies designed to assist these employees.

The results of the NIMH campaign to battle the stigma of mental illness are unclear and somewhat mixed. On the one hand, we now see published concrete guidelines to show employers how to overcome stigma and treat the rehabilitated mentally ill like other workers (4). At the same time, employers indicate concern about employee mental health problems while expressing different attitudes toward different types of problems. Crawford and Adamson (5), for instance, report a readiness to help with problems amenable to lay counseling, such as alcoholism, but a reluctance to get involved with psychiatric problems requiring expert attention, such as serious depression.

Employment of the rehabilitated mentally ill need not be a threatening experience nor one conducted simply for altruistic reasons. Indeed, research demonstrates that the vast majority of such persons are valuable and productive employees (6). One analysis of factors associated with hiring the rehabilitated mentally ill lists concrete, non-humanitarian benefits for their employment. They are: (1) obtaining federal tax credits; (2) offering the employee the opportunity to be self-sufficient, thereby reducing welfare costs; (3) hiring employees who are especially willing to work and have few problems associated with absenteeism or lateness; (4) hiring workers who have learned to handle stress-- an aspect of most jobs-- as part of their rehabilitation and treatment (4).

Studies of the status of former mental patients in American industry have concentrated on factors which can predict work performance. Psychiatric symptomatology, diagnostic category, intelligence, aptitude, personality tests and ability to function in a non-work setting are reportedly poor predictors of vocational capacity (7). Adjustment skills in a workshop, attitude toward work, general level of functioning and vocational self-esteem are reported to be positively related to vocational capacity (7,8). Of these positive factors, attitude toward work appears to be an especially important part of the vocational rehabilitation process and eventual functioning in open industry. Additionally, Dulay and Steichen (9) report that "transitional employment" between hospital-based programs and open industry employment enhances vocational and psychosocial rehabilitation of the chronically mentally ill.

Analyses of company hiring practices concerning psychiatrically handicapped exist but they are few and far between (10). One study of a hospital with its own Employee Assistance Program designed to help workers who are mentally ill and employed reported some encouraging facts (11). That program, based on early intervention and matching needs with appropriate help sources, was associated with significant improvement in the mental health of 72 of the 92 employees who participated.

Despite legislation which has encouraged equal opportunity for the chronically mentally ill in various types of vocational programs, the delivery of effective services has been far from adequate (8). Nowhere has this been more apparent than in the military where a disabling psychiatric condition automatically results in termination (12). Unfortunately, the "policy" of the military may not be that exceptional. Corporations vary widely in their practices of dealing with the mentally ill (13). In 1971, Burden reported that only a minority of American companies had formal policies on employing people whose previous emotional handicaps were serious enough to require hospitalization. Those companies who did report having polices often left many of the hiring decisions to company physicians during pre-employment physical.

Recently there has been scattered reports of employers providing more health care services for chronically mentally ill employees. Some of these services are part of the development of a new partnership between businesses and community hospitals (14). Other company services utilize outside, private, mental health care firms to bolster in-house programs for workers with mental problems before the latter are beyond help (15).

Companies using such external support range from large firms like General Mills to relatively small companies. Because of the strict confidentiality maintained, it is difficult to ascertain how many employees actually take advantage of the aid offered to them.

IBM is one of the few major companies cited in the literature which has a full-time medical/psychiatric in-house department with consultation and prevention facilities. It has also been carefully evaluated. After a two-to-three-year follow-up period, 61.7 percent of participating employees were still with the company and a majority had dramatically improved in job performance (16). That has been the situation at IBM. What is the current situation in major U.S. corporations?

The present survey provides a focus for this question. While the literature review has ranged throughout the scattered studies involving corporations and the mentally ill, the precise problem addressed below concerns existing (or planned) corporate policies specifically developed for the psychiatrically handicapped. The analytical spotlight will be trained upon hiring/promotion policy, and upon perceptions of the on-the-job behavior of psychiatrically handicapped employees within firms that do and do not have such policies.


A questionnaire was jointly developed by ALTRO Health and Rehabilitation Services, Inc. and Villanova University's Human Organisation Science Institute. The instrument was then scrutinized by three directors of Human Resource Development from major corporations and two Human Resource private consultants. Inputs from this "expert review" were used to make final modifications. The resultant instrument, entitled "National Survey of Corporate Policy Concerning the Psychiatrically Handicapped," consisted of fifteen items (with subpoints) and could ordinarily be completed in less than ten minutes. Fortune 500 contact information was secured for all 488 corporations that were included in the "Fortune 500" listing at the time of the survey. This information included: name/address/phone of personnel director and industrial classification.

A first mailing was sent out on August 15, 1986 and 46 responses were received. A second mailing to non-respondents (October 3, 1986) yielded another 47 responses. In order to reach a target of at least 100 responses, phone calls were made by trained interviewers, on a random basis, to non-respondents beginning November 11, 1986. When possible, the phone interviewers completed the instrument over the telephone using a standardized protocol, but at the very least they stressed the import of the study and again requested a completed response. This "quota sampling" phone follow-up yielded another 34 responses. The final tally for the sample was 127 corporations for a response rate of 26 percent. Given a sampling frame consisting of Fortune 500 companies (a notoriously oversampled population) we consider this a more than acceptable rate.

As is appropriate in such an underresearched area, much of the "news" is apparent in simple item analyses. Although the bulk of our results' interpretation involves such frequency breakdowns, statistical significance testing was performed using the log-linear likelihood-radio statistic (G2). The likelihood-ratio is interpreted analogously to the traditional chi-square statistic, but has certain multivariate advantages in applied studies such as this (17). Notably, the "partial association" algorithm (from BMD subroutine P3F) permits a direct test of a two-variable association in a three-variable table when the other two-variable associations are under statistical control.


Some of the most telling data on national corporate policy concerning the psychiatrically handicapped emerge from simple queries about the existence-- or nonexistence-- of such policies among Fortune 500 companies. Of the 127 respondent corporations, only 13 "have a formal policy (i.e., written regulation) specifically concerning the hiring of the psychiatrically handicapped," only 11 corporations have a formal policy specifically concerning their promotion and advancement. Even if the policy definition is broadened to include "informal" hiring or promotion/advancement policies, approximately 23 percent of responding Fortune 500 companies have any kind of corporate employment policy specifically for the psychiatrically handicapped.

Given this fundamental finding, there are two related issues to be addressed. First, what is the nature of the policies now operating within large corporations? Second, what are current attitudes toward the psychiatrically handicapped underpinning current corporate policy-- or the lack of it?

Table 1 is a master display of the contents of extant corporate policies. By far the most popular response characterizing current programs is the evaluation of the psychiatrically handicapped "on the same basis" as the physically handicapped; note the 29 respondents (22.8%) registering a yes on the hiring item and the 30 respondents (23.6%) answering yes for promotion and advancement. The latter responses appear in stark contrast to items about special treatment. "preferential consideration" in the hiring of the psychiatrically handicapped is part of only 3 corporate policies (2.4%); "preferential consideration" in promotion and advancement is present in only a single case (.8%). Similarly, only one company has established "hiring goals" for the psychiatrically handicapped. While 8 firms (6.3%) themselves provide "extra monitoring and/or support from supervisors" after hiring the psychiatrically handicapped, 18 firms (14.2%) maintain formal links between the company and some external mental health provider. Table 1 shows that the most common formal relationships are with Employee Assistance Programs (15 firms for 11.8%) and private psychiatric or psychological counselors (11 firms for 8.7%).

The survey also probed the rationales for current programs. According to a separate item (no table shown), the "main reason for the implementation of [the] company's policy concerning the psychiatrically handicapped" cited most often was Affirmative Action (20 firms). Relatively few companies cited "management advocacy" (3 firms) or "public relations" (1 firm) as the primary rationale. Interestingly, not a single firm cited "economic incentives (i.e., the Targeted Jobs Tax Credit)" as the main reason for implementation.

Because the literature review had attuned the investigators to the likelihood that only a minority of corporations would have an employment policy operating for the psychiatrically handicapped a number of questions were directed to all Fortune 500 respondents. It appears that the immediate future will bring little change in the paucity of policies documented here, with only one company in the entire sample "currently working on the development of a formal or an informal policy concerning the psychiatrically handicapped." It is also apparent that simple familiarity with external economic incentive programs such as the Targeted Jobs Tax Credit does not translate directly into an employment policy. Such familiarity is already widespread, with the preponderance of firms (94 of 127 for 74%) indicating awareness of that program; futhermore, data cited above indicate that such incentives were not the main reason for the implementation of even a single extant policy. Neither current corporate deliberations nor a tax incentives information campaign presage a major expansion of employment policies for the psychiatrically handicapped.

It is plausible that the arrested development of these policies in major corporations reflects a pattern of general attitudes toward the psychiatrically handicapped. One way to overview such attitudes is to poll the entire sample concerning the relative desirability of various types of potentially stigmatized workers. In particular, respondents were asked to "rank [for their companies] the following categories of applicants in terms of their desirability as employees: alcohol/drug problems, ex-offenders, mentally retarded, psychiatrically handicapped and physically handicapped." While the entire response distribution cannot be reproduced here, several data are worthy of special note. First, individuals with alcohol/drug problems are clearly scored to be the least desirable employees; they receive 50 fifth-place ranks (five being the "least desirable" category, first the "most desirable", etc.), over twice as many as the 23 last-place votes for ex-offenders. Second, the physically handicapped appear to be the most desirable of the five types of individuals, with 79 first-place ranks. Third, the psychiatrically handicapped display an unusually symmetrical response pattern with 5 first place desirability ranks, only 8 last place ranks, and exactly 26 companies ranking them second, third and fourth, respectively. The latter desirability response pattern approximates that of the mentally retarded.

These findings mirror the corporate cultures of Fortune 500 companies, but more direct measures of the attitudes bearing on programs for the psychiatrically handicapped are exhibited in Table 2. The item that elicited these responses was worded as follows: "Please indicate the importance of each of the following factors as barriers to implementing a more extensive employment policy concerning the psychiatrically handicapped: very important, somewhat important, unimportant." Please note that this question is flexible enough to apply to Fortune 500 companies both with and without extant policies, and note further that Table 2 is divided along these lines (the first panel consists of those with, the second panel of those without such a policy). Before examining substantive differences in attitudes, broad disparities in response are apparent across the two panels. Observe that for nine of the ten "barriers," a higher -- often far higher -- percentage of "without policy" respondents select the "very important" response (the single exception is "concerns about appearance," in which only one "with policy" respondent circled "very important"). Conversely, for nine of the ten "barriers," the percentage of "unimportant" responses among corporations having policies exceeds those of corporations with no policy. The apparent assessment of lesser importance for this set of "barriers" in the top as compared to the bottom panel is confirmed by a statistically significant likelihood-ratio value of 30.76 (for the test of the two variable partial association, p.001). We would infer that Fortune 500 companies lacking current policies perceive implementation problems to be more onerous than do companies already operating programs for the psychiatrically handicapped.

Within this general pattern, we would also spotlight the responses for specific "barriers." Concerns about "appearance" and "rule infractions" are relatively low, which is an intriguing finding given popular stereotypes about the chronically mentally ill. Although concern about "tardiness" is similarly low, "absenteeism" concerns are relatively high among "with policy" and "without policy" respondents alike. The latter finding cannot be simply interpreted to mean that current corporate policies validate special fears about absenteeism among the psychiatrically handicapped. We can say this with some assurance because a separate item (no table shown) asked only respondents from the "with policy" group to "indicate your company's general assessment of psychiatrically handicapped employees relative to non-handicapped employees". Since half of the respondents to the latter item called the psychiatrically handicapped "no different" from non-handicapped employees in absenteeism (and only one company responded "very different"), the responses of the "with policy" group in Table 2 may simply reflect a general concern about absenteeism for employees of all types. Perhaps the most striking data involve company resources rather than attitudes toward the psychiatrically handicapped themselves. Note that about one-fifth of both "with policy" and "without policy" respondents assess "excessive cost" to be "very important." There is no such parity on the "lack of expertise" and "legal considerations" barriers, which loom much larger in the concerns of companies without policies.

Discussion and Conclusions

To the authors' knowledge, the present report is the only current study of national corporate policy concerning psychiatrically handicapped employees. Among this subject population of Fortune 500 firms, only the clear minority--roughly one-quater--of corporations have such a policy in place; even this figure should be considered an upper boundary for our inference given the likelihood that firms without a policy are over represented among non-respondents. Among firms with one, the policy most often consists of a general "equal treatment doctrine" regarding the hiring/promotion of the psychiatrically handicapped vis-a-vis the physically handicapped. Within the sample as a whole, however, the physically handicapped are clearly preferred to the psychiatrically handicapped as more desirable employees. When the sample is broken down into those firms with and those without corporate policies concerning the psychiatrically handicapped, striking attitudinal differences emerge. Notably, there is a statistically significant difference in the importance attributed to various policy barriers across the with policy/ without policy gap. Firms lacking policies generally perceive the implementation barriers to be more onerous than do firms with policies; the former are both more concerned about the on-the-job behavior of psychiatrically handicapped employees, and more concerned about organizational issues such as expertise and legal considerations that bear directly upon implementation. It is our interpretation of these data that well-publicized demonstration ambivalent attitudes toward those already extant concerning physically handicapped employees, thus facilitating the development of corporate policy concerning the psychiatrically handicapped. This general recommendation can be further specified into two sets of applied implications. First, the data documenting differential perceptions by firms with and without a corporate policy should be integrated into training programs for mental health practitioners. The findings have direct applications in the job counselling of the psychiatrically handicapped individual, as well as in the continuing counselling relationship once the individual is employed. Such supportive information is also invaluable to mental health advocacy groups promoting the employment of the psychiatrically handicapped.

The implications for further research are similarly straightforward. It bears repeating that this is the first and only study in this area. Additional studies of major corporations would profit not only from replication, but also from more precise specification of policy content (e.g., is the "equal treatment" policy a blanket one or is it specially developed for the psychiatrically handicapped? Is there follow-up data?). Even more significantly, the employment policies of non-Fortune 500 companies--businesses containing the vast majority of employment opportunities for the psychiatrically handicapped -- remain wholly unexplored.


This project was funded under a grant from ALTRO Health and Rehabilitation Services, Inc. Special thanks are extended to Lisa Parmelee for computer programming assistance.

Footnotes (1) Long, E. and Runck, B. (1983). Combatting stigma through work for the mentally restored. Hospital and Community Psychiatry, 34, 19-20. (2) Goldman, H.H. and Manderscheid, R.W. (1987). Chronic mental disorder in the United States. In: National Institute of Mental Health. Mental Health. United States. 1987. Manderscheid R.W., and Barrett, S.A., eds. DHHS Pub. No. (ADM) 87-1518. Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office. (3) U.S. Bureau of the Census (1986). Disability, functional limitation, and health insurance coverage: 1984/1985. Current Population Reports, Series P-70, No. 8. Washington, D.C.: U.S. Government Printing Office. (4) Solomon, J.R. (1986). Why hire the rehabilitated mentally ill? Management Review, 75, 69. (5) Crawford, R.L. and Adamson, H. (1980). Managerial responses to mental disorders among employees. Journal of Occupations and Medicine, 5, 309-315. (6) Burden, C.A. (1971). Hiring a mental rehabilitant. Personnel Journal, 50,920. (7) Anthony,W.A. and Jansen, M.A. (1984). Predicting the vocational capacity of the chronically mentally ill: research and policy implications. American Psychologist, 39, 537-544 (8)Klein, M.E. (1985). Influences on the employment status of psychiatrically disabled clients. University Microfilms, ADG85-24222. (9) Dulay, J.L. and Steichen, M. (1982). Transitional employment for the chronically mentally ill. Occupational Therapy in Mental Health, 2, 65-77. (10) Faulk, R. and Burden, C.A. (1975). The emotional process for rehabilitants: two studies of the hiring of emotional rehabilitants. Personnel Journal, 54, 529-531. (11) Bednarek,R.J. and Featherston, H.J. (1984). Employee assistance program treats personal problems. Hospital Programs, 65, 44-47. (12) Mental and Physical Disability Law Reporter (1985). Employment: mental disability retirement upheld, 9, 197. (13) Price, B. (1978). Mental illness: a case for company concern. Personnel Management, 10, 39-43. (14) Katz, I.B. and Pascarelli, E.F. (1984). Employee assistance: a business and community hospital partnership. Journal of Hospital and Health Services Administration, 29, 49-57. (15) Business Week (1979). More help for emotionally troubled employees, 2576, 97-102. (16) Robbins, D.B.,Kaminer, A.J., Schussler, T., and Pomper, I.H. (1976). The psychiatric patient at work. American Journal of Public Health, 66, 655-659. (17) Knoke, D. and Burke, P. (1981). Log-Linear Models. Beverly Hills: Sage.
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Author:Massari, Louis O.
Publication:The Journal of Rehabilitation
Date:Oct 1, 1991
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