Mental Health and Work

by Marie Hartwell-Walker, Ed.D.
Karen returned to work after a three-month medical leave. Diagnosed with bipolar illness many years ago, her symptoms had been successfully managed with medication and Karen's own hard work in psychotherapy. A manic episode, seemingly from "out of the blue," made it impossible for her to work for a few months. She needed the time to adjust her medication and to deal with her own feelings about this re-emergence of symptoms. She didn't expect any problems when she went back to work. An experienced nurse, she thought her colleagues at the local hospital would welcome her back just as they always welcomed any other person who had been away for a time due to illness. She was wrong. Most of the staff didn't mention her leave at all. Those that did were clearly uncomfortable. Some people seemed to be pointedly ignoring her. "We're medical people, for heaven's sake," she said to me in our first session. "We're used to people getting sick - and getting well. What's the big deal?"

Tom took an extended leave of absence as he struggled with a severe and debilitating depression. For weeks at a time, he couldn't get out of bed, much less function at his high-pressure sales job. Although he had been the top performer at his company for the past five years, he was laid off when he tried to go back to work. His job, he was told, had been "redefined" so that he was no longer qualified. Tom was devastated. "What kept me going through the worst of the depression," he told me, "was thinking about getting back to work. Work for me is what keeps me going." He went on to say that he had thought that famous people like Hugh Downs and Henry Kissinger coming forward about depression made it more acceptable. "I found out differently. If you're just a working guy instead of some big wig, depression is the kiss of death at work," he said angrily.

We live in a culture in which most medical diagnoses (with some notable exceptions like AIDS) are immediately responded to with sympathy and concern. But when a person is diagnosed with a mental illness - particularly a mental illness with psychotic features - a good many people respond as people once did to lepers: with discomfort, disdain, distancing, and even outright fear.

These reactions are often painfully obvious in the workplace when an employee either shows symptoms of mental illness or when he or she tries to return to work. Without the bonds of love, family, or long friendship to sustain the relationship, people's insecurity and fears about mental illness can surface in surprising and hurtful ways in the workplace. Employers wonder if the person can still do the job. Supervisors, worried about legal implications, fear saying the wrong things, and often say nothing at all. Co-workers don't know how to respond. Customers may be confused about the sudden unexplained absence and return of a favored contact in the company. The resulting awkwardness and tension make it difficult for an already fragile employee to do his or her job.

Double Trouble

Shame or fear can exact quite a price. To avoid the real or imagined consequences of telling an employer or co-workers about his or her illness, the employee tries to "tough it out" alone. Some people don't use their insurance for fear that it will alert their employer to their problems. Some put off getting treatment. Still others find a psychotherapist many miles away from home to prevent discovery. Those who use any of these tactics find themselves with a double problem: the original symptoms of an often frightening mental illness plus the enormous anxiety that their secret will be discovered.

It often becomes easier for the employee to leave the job than to put up with feeling like an outcast or to manage the worry about discovery. The company loses a good employee. The employee loses a good job. And the stigma and confusion about mental illness continue. People like Karen and Tom end up suffering many times over: first from a mental illness, then from the stigma associated with being mentally ill, then from the loss of self-esteem that comes with feeling that they failed at work.

Enlightened Workplaces

Enlightened workplaces are those that understand the give-and-take of the employer-employee relationship. Employees who are treated with dignity and respect usually become loyal, hard-working members of the team. In an economy in which employees have choice about where they will work, it is only smart business for a company to develop existing employees and to go the extra mile to keep good people who sometimes go through difficult periods.

In such a company, a person who is known to be returning from an episode of mental illness is treated with dignity. Consistent support from management makes it clear to all employees that there is no room for negative attitudes towards a co-worker who has been on leave for something like depression. In situations in which the employee has asked that confidentiality be kept about a mental health leave, supervisors must respect that request. At the same time, the employee deserves support while he or she works to return to former levels of productivity.

How to Support a Valued Employee Who is Managing Mental Illness:

  • Companies can provide important accommodations to the employee managing a mental illness, just as they do for people who are still recovering from an injury or managing a physical condition. Reduced hours, flexible scheduling, job-sharing, a temporary change in responsibilities, time-off for appointments, etc. can help a valued employee get back to work and reclaim self-esteem.

  • Participating in events like World Mental Health Day or National Depression and National Anxiety Screening Days helps send the message that the company understands the nature of mental illness and expects people to get help not get out when they feel overwhelmed, stressed, or anxious.

  • Providing workshops on Stress Management, Communication Skills, Anger Management, Addictions, etc. is a proactive approach to common employee problems. High-pressure jobs leave people vulnerable to overload. The smart employer works to develop employee skills for working with each other and for handling frustration and stress.

  • Offering an Employee Assistance Program (EAP) as part of a benefits package enables workers to get early, effective help and referrals for mental health problems while at the same time protecting personal privacy. It's a low-cost addition to the benefits menu that can pay off in a big way in terms of employee longevity and loyalty.

Celebrate World Mental Health Day

Nearly one in two Americans (that's almost 50%!) will suffer from a mental health disorder at some point in their lives. It may be as mild as an adjustment disorder to a major life change or as severe as the onset of schizophrenia. Regardless, nearly half of us will at one time or another feel overwhelmed, frightened, and insecure as we try to deal with feelings and/or thoughts that threaten to envelop us. Whether it lasts for a week or for several years, we need the understanding and support of family, friends, and co-workers while we get the treatment we need and get back to our usual selves. World Mental Health Day (October 10), sponsored by the World Federation for Mental Health, is intended to help remind all of us of the importance of reducing the stigma associated with mental illness in our communities and in the workplace. This year's theme, in fact, is "Mental Health and Work."

For more information on World Mental Health Day, go to:

Date published: 9/27/00
Last reviewed: By John M. Grohol, Psy.D. on 30 Apr 2016
    Published on All rights reserved.