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June 26, 2020
For those who have experienced life-altering events or diagnoses, getting a job may be the last thing on their mind. They may consider it out of the question altogether. But it turns out that working has significantly more value than a paycheck alone. Karen L. Jacob, PhD, program director of McLean’s Gunderson Residence, encourages patients to find employment as part of the healing process.
“Working has been shown to help stabilize people struggling with mental health conditions,” Jacob said. In her work with patients who experience borderline personality disorder (BPD), she added, a critical aspect of recovery often involves engaging in a work setting. It provides daily structure and meaningful experiences.
“This may result from the work itself or interactions someone has with coworkers or supervisors,” Jacob said. Through such experiences, people have the opportunity to master skills frequently developed in therapy, such as managing their emotions or getting along with others. They also develop a sense of competency in the work itself.
The late John G. Gunderson, MD, a pioneer in the diagnosis, treatment, and research of BPD, and founder of the McLean program bearing his name, promoted the relevance of work in patients with BPD. He noted the positive impact that employment had on patients’ emotional growth and well-being.
Working not only promotes growth and stability in those with BPD but also across mental health conditions. The Veterans Affairs Administration offers a compensated work therapy program for veterans experiencing a range of mental health conditions. The program connects veterans to workplaces that match their strengths, skills, and needs as a way to build resilience and bring experienced employees to workplaces.
Jacob said she has seen many patients flourish once they engaged in the workforce. One individual, who struggled with BPD, narcissistic personality disorder, PTSD, and substance use, encountered many obstacles throughout her treatment in a residential program. She managed to address the core issues that led to her impulsivity and substance use. Once she completed her program, Jacob said, she found employment, and while the job was not quite the right fit, it provided structure and stability.
“Not only was she able to develop significant connections with her colleagues while at work, but she learned to regulate her emotions in the context of inevitable obstacles in the workplace. It led to her feeling more competent. Eventually, it led her to seek out a job in line with her long-term career goals. This was her stepping-stone to stability.”
Though working can be helpful for those with mental health conditions, it can be difficult to navigate.
In general, employees are protected against discrimination when disclosing mental health issues in the workplace under the Americans With Disabilities Act (ADA) of 1990. These rights are protected by the Equal Employment Opportunity Commission (EEOC) to ensure employers understand their responsibilities and that employees understand their rights.
“These guidelines promote equal rights for employees who disclose mental health disability, assuming that the employee can reasonably perform at work and is not a threat to themselves or coworkers,” Jacob said. “Employers are required to make reasonable accommodations to support the employee’s disability. They are required to keep these disclosures confidential unless presented with extenuating circumstances that compromise the employee’s health and well-being or that of their colleagues.”
Jacob added that it’s important for employees to ask the right questions when they consider sharing information about their mental health. Stigma still exists for many conditions, and people should consider a range of factors before they disclose their illness.
“What would be the purpose of disclosing?” Jacob said. “Is it necessary for them to do their job? Is their mental health interfering with performance? Is it impacting themselves or their colleagues?”
She added that the most pressing reason for someone to disclose their condition would be if their mental health condition had the potential to impact performance, or if they could potentially be a threat to themselves or others.
Sharing such information naturally has its challenges, including feeling being judged by coworkers or supervisors. Disclosure can affect camaraderie, as well as performance.
“Together, these factors can impact one’s emotional stability. This is clearly counter to the hope of having work structure contribute to emotional stability,” Jacob said.
There are clear obstacles to sharing mental health experiences in the workplace. But one of the biggest benefits of sharing is that employers can provide support if obstacles emerge.
Jacob suggested both employers and coworkers follow the model of “unconditional positive regard.” Carl Rogers is considered the father of the humanistic patient-centered approach to therapy. He encouraged clinicians to take a nonjudgmental and supportive attitude toward people who struggle with mental health challenges. “In the workplace, this wouldn’t involve helping a colleague change. But it would more likely foster understanding and connection in that environment,” Jacob said.
She added that people who have experienced mental health challenges often bring strengths to the workplace. They are more likely to be attuned to vulnerabilities and how such struggles have created hurdles in their lives.
“This awareness allows for understanding of themselves and of others that creates an empathetic environment,” she said. “That environment has the potential to promote personal and professional growth. Work expectations may not change but can be reached in a more supportive way.”