It is very likely that you, or someone close to you, will experience a mental illness in the course of a lifetime. Just like physical illnesses, the symptoms of mental health disorders can range from mild to severe, and even become debilitating and disabling for some. Symptoms can be long-term and reoccurring, or only episodic. Coping with symptoms can be challenging, but there are additional obstacles that many with mental illness face every day. Unfortunately, they may also encounter stigma, inequalities, and discrimination in many areas of their lives.
A great deal of social stigma still exists about mental illness. People, including friends and loved ones, may misunderstand mental illness and how it may, or may not, impair functioning. They may assume that people with a mental illness cannot be successful at work, at school, or in relationships. They may fear interacting with people with mental illness, or be apprehensive about renting a home to them, or hiring them for a job. Some may believe that people with mental illness always experience impaired functioning due to their illness, but this is not the case, and these misperceptions can lead to stigma and discrimination against those with mental health disorders.
It is possible for people with mental illness to recover and to manage symptoms of their illness very successfully. They are able to be successful employees, parents, and community members, but may need some support and accommodations to be successful. According to the U.S. Department of Health and Human Services (2014), mental illnesses are some of the most common causes of disability in both the U.S and in Canada. In any given year, up to 1 in 17 Americans will experience a severely debilitating mental illness (Mental Health and Mental Disorders, 2014).
The symptoms of a mental illness may, or may not, create impairment or disability. Many people with mental illness live full and productive lives, with minimal difficulties. However, just like people with physical health conditions, people with behavioral health disorders may experience symptoms that can interfere with their ability to work or participate in social activities. The symptoms of mental illness can cause varying degrees of impairment and disability, and those with mental health disorders may experience discrimination and inequities in many different parts of life, including employment and finding a safe and stable place to live.
Disability, Impairment, and Behavioral Health Disorders
For some, the symptoms of mental illness create a degree of impairment and disability. The degree of impairment can vary significantly, even among those with the same disorder. For example, one person with a Bipolar Disorder may experience severe impairment, limiting his or her ability to work or function in social situations, while another person with the same diagnosis may experience very limited difficulty related to the disorder. Many factors contribute to the amount of impairment or disability a person experiences, and the federal government in the U.S. considers a number of factors when determining the degree of disability due to a mental illness. According to the Americans with Disabilities Act (ADA), passed by President George Bush in 1990, a person with a mental illness must meet one of three of these criteria to be considered disabled by their illness:
- "a physical or mental impairment that substantially limits one or more major life activities of an individual or”
- “there is a record of such an impairment or”
- "they must be regarded as having such an impairment." (Mental Health, 2010)
It is also important to understand that the ADA defines ”mental impairment” as "any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities” (NAMI, 2009). Because people with mental illness can experience disability as defined by the Americans with Disability Act, they are entitled to certain rights and protections under the Act. This ACT primarily focuses on employers, public services, and government entities; it prohibits discrimination against people with disabilities, including those disabilities caused by mental illness (NAMI, 2009). This helps ensure that people with mental illness are treated in an equitable way, without discrimination. But, laws and regulations can only go so far in reducing stigma and preventing discrimination. Society must become educated about mental illness, and have the opportunity to interact with people with mental health disorders.
Understanding Mental Illness
In order for those with mental illness to be treated fairly, in all areas of life, everyone must better understand mental health disorders and how they really affect people. Harmful myths must be dispelled in order decrease stigma and discrimination. Almost 90% of people with mental health disorders say that stigma has negatively affected their life and led to discrimination. For example, the erroneous belief that people with mental illness are violent and dangerous can lead to discrimination and inequities, creating more problems and barriers for those with mental illness. Of all people with disabilities, people with mental illness are the least likely to find work, be in a long-term relationship, live in safe and stable housing, or be socially included in mainstream society (Stigma and Discrimination, 2014).
Stigma and discrimination can trap people with mental illness in a vicious cycle of inequity and stress, and even exacerbate their symptoms. Research tells us that the most effective way to combat stigma and discrimination is for people to have personal contact with people with mental illness. One anti-stigma program called Time to Change found a number of ways to combat and reduce the stigma that can lead to inequitable treatment of those with mental illness. They found that school curriculums that include education about mental health can really change kids’ attitudes. They also found that testimonials given by people with mental health disorders can change the perceptions of police officers (Discrimination and Stigma, 2013). Regular interactions with people with mental illness at work, school, and in the community can decrease stereotypes and increase the likelihood that these people with be treated fairly in our society (Stigma ,2014).
Equality in the Workplace for People with Mental Illness
Employment can be directly related to good mental health. Being excluded from the workforce can be very detrimental for people with mental illness. Employment enables people to be self-sufficient and avoid the trap of poverty. It is also a source of personal satisfaction, self-worth, and personal identity. Employment can be a step toward independence and recovery for people with mental illness, and the inability to find or maintain employment can keep them isolated and dependent on others. People with mental health disorders have the right to live and work in communities, and they deserve equal access to pursue employment opportunities (Stuart, 2009).
People with mental health conditions may face discrimination and inequities in their workplace, and it’s important to be aware of the rights and accommodations they may be entitled to under the Americans with Disabilities Act. According to the ADA, discrimination against those with a mental illness is prohibited in all types of employment practices, and employers must make reasonable accommodations to enable people to be successful at work (Questions and Answers, 2008).
The fear of discrimination and stigma can make it difficult and frightening for a person to disclose their mental health diagnosis to their employer. In a 2012 study in the United Kingdom, approximately 500 individuals with a diagnosis of schizophrenia were surveyed. Over 80% of those surveys said their diagnosis made life more difficult and that they believe people associate their diagnosis with violent behavior (Discrimination and Stigma, 2013).
In another study done by the Institute of Psychiatry, Psychology and Neuroscience, In London, more than 700 people with a diagnosis of schizophrenia in 27 different countries participated in interviews about stigma. Seventy-two percent of those interviewed said they felt a need to hide their mental health diagnosis, and 64% said that the fear of discrimination prevented them from applying for work, education, or training opportunities (Discrimination, 2013). It’s clear that the fear of discrimination limits those with mental illness in their pursuit of work and other opportunities. However, if employers don’t know about their employee’s mental health disorder and their needs, they cannot provide accommodations that help the employee to be successful.
According to the U.S. Equal Employment Opportunity Commission (EEOC) (2014), some reasonable work accommodations that may be helpful for people with mental illness include:
- Altered break and work schedules (e.g., to accommodate medical appointments)
- Time off for treatment appointments
- Changes in supervisory methods(e.g., providing written instructions, or breaking tasks into smaller parts)
- Eliminating a non-essential (or marginal) job responsibilities that someone cannot perform because of a disability
- The opportunity for tele-work / working from home
- Reassignment to a vacant position when an employee can no longer be successful in a position because of their disability (The Mental Health Provider’s Role, 2014).
These are just a few accommodations that may be helpful, and employees with mental illness can discuss other needs for accommodations with their employer. It can be helpful for those with mental illness, or their representatives, to explain to employers how accommodations can help their employee be productive and successful.
Equal Access to Housing for People with Mental Illness
In addition to barriers to employment, lack of access to safe, stable, and affordable housing is often a problem for people with mental illness and substance use disorders. Stable housing is the foundation for stability in other areas of life, and most people would struggle if they did not have a safe place to call home. As with employment access, federal law prohibits discrimination against people with mental illness who are seeking housing. However, too many people with mental illness are homeless, or lack consistent safe housing and discrimination can be one factor that contributes to this issue.
According to the National Coalition for the Homeless while only 6% of the general population have a mental illness, 20-25% of the homeless population have a severe mental health disorder. Additionally, a 2008 survey of the mayors of 25 U.S. cities revealed that mental illness was the third largest cause of homelessness for single adults in those cities (Mental Illness and Homelessness, 2009). While there are many factors that may contribute to homelessness for people with mental illness, stigma and discrimination can also play a role.
The Substance Abuse and Mental Health Administration (SAMHSA) has identified a phenomenon called “Not in My Backyard” (NIMBY) Syndrome. This “syndrome” is caused by fear of and misunderstanding about people with mental illness. It occurs when people protest housing for people with mental health disorders in their neighborhood. They fear it will lower their property values, and worry about their children interacting with people with mental illness. This fear and stigma can lead to discrimination, and can make it difficult for people to integrate into communities (Housing, 2012). However, the inability to integrate into society keeps people with mental illness isolated and marginalized, and even exacerbates symptoms of mental illness.
Gainful employment and stable housing are necessary for almost everyone to be successful members of society. When access to either of these is limited, life becomes very difficult. People with mental health disorders deserve the same access to employment and housing to enable them to be safe and contribute to their communities and feel worthwhile and valuable. Unfortunately, stigma and discrimination still create inequities for people with mental illness, and as a society it benefits us all to work hard to increase acceptance and decrease stereotyping and misperceptions about people with mental illness.
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