This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network |
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This Web site is a component of the SAMHSA Health Information Network. |
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BackgroundThis section describes the study design and implementation and then provides information about each of ten workers and their employment settings. It offers a context for the subsequent sections which present findings on disclosure, functional limitations, and accommodations. Study Design and Implementation Site Selection In order to gather information about accommodations for workers with psychiatric disabilities, interviewees were pre-selected for certain characteristics. The study design required the selection of 10 sites where: a. the worker had been diagnosed with a serious mental illness and had associated functional limitations that were likely to meet the ADA's definition of individual with a disability; This approach to information gathering may be called elite interviews. A limited number of individuals known to have experiences relevant to the subject were chosen. Therefore, interviewees were not randomly selected. Within these guidelines, I identified sites through professional contacts in various regions of the country (East Coast, Midwest, and West Coast). I sought diversity in: types of work settings (i.e., industrial, white-collar office, service sector), levels of employment and compensation, educational background, and racial/ethnic traits of workers. Interview Protocol Prior to beginning the interviews, I established protocols for the employee and employer interviews in order to standardize the information being collected as much as possible. (The interview protocols appear in Appendices I and II). Information was gathered from each worker in the following categories:
These data are presented by a series of tables in Appendix III Workers were also asked questions in the following areas:
Supervisors were asked questions in the following categories:
Interview Format Face-to-face interviews with workers and their supervisors were conducted between November 1992 and March 1993. (In one case, the employer interview was conducted by phone.) Interviews were conducted separately, rather than simultaneously, with each worker and his or her supervisor. Supervisor interviews lasted from 30 to 90 minutes, averaging 45 minutes. The shortest worker interview was 60 minutes, and the longest lasted 2 ½ hours. The average was 90 minutes. Anyone interviewed outside of his/her normal working hours received a $25 honorarium. In most cases, the interviews were audiotaped and transcribed, so that direct quotes could be recorded. Interviews with two employers were not audiotaped, based on their preferences. Interviews were conducted at the worksite, if possible, in order to observe the work setting. Selecting the Supervisor In three cases, there were several supervisors involved, and the immediate supervisor was not prepared to respond to all of my questions. In each of these cases, I conducted additional interviews with higher-level administrators. In several cases the worker had more than one supervisor. This posed problems if significant events had occurred prior to the current supervisor's arrival. In one case I was able to obtain additional background information by contacting a higher-level manager who had been involved (e.g., by making decisions about medical leave). In two other cases, these early events are represented from the worker's perspective only. In two cases, the worker's most relevant experience was at a former job. In one case, I interviewed the previous supervisor by phone and thus did not observe the worksite. In another instance, I interviewed the employer at the former work site. In both cases, it had been less than six months since the ending of the employment situation we discussed. While a retrospective interview poses certain problems, the insights offered by the interviewees were still extremely vivid. Self-Reported Effect of Our Discussion on Those Interviewed While I felt grateful to the workers for agreeing to meet with me and share highly personal information, most workers expressed their appreciation for the opportunity to talk about their current and previous experiences. Four workers used the term therapeutic to describe the interview. One worker reported that the interview might help him leave behind certain negative feelings he had about past events. One worker asked for a copy of the interview transcript for his personal use. Most of the employers stated that they were glad to have the opportunity to contribute their own experiences for others' benefit and requested a copy of the final report. Scope of Report This report is intended as a resource to those involved in ADA implementation, including workers with disabilities, employers, and employment service providers. It is not a comprehensive introduction to the employment provisions of the ADA. For an overview of the law as it applies to workers with psychiatric disabilities, consult the booklet, Mental Health Consumers in the Workplace, available from the Bazelon Center for Mental Health Law, 1101 15th Street, NW, Suite 1212, Washington, DC 20005-5002. Additional resources on the ADA and workers with psychiatric disabilities are listed in Appendix IV. Characteristics of Workers and Their Work Sites Characteristics of Workers Some worker characteristics are summarized below: Each of the workers had been diagnosed with a serious mental illness: five have been labeled as having schizophrenia, three as having bipolar disorder, one with organic personality disorder, and another with a combination of major depression, multiple personality disorder, and anorexia/bulimia. Three of the workers described themselves as in recovery from alcohol and/or drug abuse.
The work histories and psychiatric treatment experiences of the 10 workers are summarized below. As indicated on page ii, all of the names have been changed Judy works full-time as an associate editor at a publishing company on the East Coast. She has a bachelor's degree in music and has taken graduate course work. She has 16 years of experience as an elementary school teacher. Judy has been with her current employer for six years, during which time she has had 13 psychiatric hospitalizations. At various times, depending on the frequency of her absences, she has been a salaried worker, a contract worker (i.e., given contracts for six months at a time), or a freelance editor (i.e., with month-to-month assignments). Her first hospitalization occurred after she had been on the job for seven weeks. Judy has been diagnosed with multiple personality disorder, major depression, anorexia, and bulimia. She takes Prozac, Ativan, Trilafon, and Benadryl. She sees a psychologist two or three times per week and estimates that she spends $8,000 per year on psychiatric treatment that is not covered by insurance. Vince works part-time as a delivery driver for the pizza delivery unit of a national corporation in Southern California. The site employs 30 people. At the time of his interview, Vince had been on the job for five months. His supervisor reported that the average turnover for the position was 220 percent annually. When Vince took this job, he had been unemployed for 12 years. Vince completed high school and is currently taking classes at the local community college. He receives SSI and SSDI. He has had five psychiatric hospitalizations and takes Haldol and Cogentin. His psychiatric diagnosis is schizophrenia. He sees a psychiatrist once per month and is assisted by an employment training specialist. He has lived in several cities on the West Coast and has been homeless for prolonged periods on two occasions. He enjoys driving, even when he's not on the job. He hopes his next job will be as a courier or messenger. His long-term career goal is to work in computer-based graphic arts. Ben works part-time as the head assistant counselor at a private, non-profit mental health agency in California. He serves as a peer counselor at a social rehabilitation program that serves 30 to 50 individuals per day, where he plans and leads group activities and counsels individual members. Prior to taking this job, he was a client of the agency for about two years. His present supervisor knew him in that capacity. Ben was in the Marine Corps Reserves while he attended college. His college education was interrupted by his first psychiatric hospitalization after his junior year. He has been hospitalized twice since then. He has been diagnosed with schizophrenia and takes Stelazine and Cogentin. He sees a psychiatrist and a case manager monthly, and the case manager is available 24 hours per day, as needed. Ben rents a house with three other recipients of mental health services. He would like to return to school to become trained as a physical therapist. Bill has been a professional musician for 19 years. We discussed his experiences as a part-time peer counselor, then full-time program counselor at a social rehabilitation agency in California. He is married and has one child. In previous jobs, he was a retail stock clerk and a bank teller. His first psychiatric hospitalization occurred while he was in college, and he has been hospitalized on one other occasion. He has been diagnosed as having schizophrenia and sees a psychiatrist once per month. He is a recovering alcoholic and attends Alcoholics Anonymous (AA) meetings weekly. Since leaving the rehabilitation agency, Bill has been working part-time as a cashier at a department store, while performing as the staff pianist at a church and for a choir at the local high school. Brian works 10 hours per week as part of the warehouse crew at an industrial materials recovery facility on the West Coast. Me facility employs 70 people and has annual revenue of $7 to $ 10 million. Brian has been on the job for over two years. Prior to that, he was unemployed for about four years. He has a high school diploma and was in the military for about six months, where he completed basic training before receiving an honorable discharge (for medical reasons). He has previously held a number of short-term jobs in fast food restaurants and worked as a salesman in a department store. Brian receives SSI and SSDI. His psychiatric diagnosis is schizophrenia. He has had one psychiatric hospitalization. He sees his psychiatrist, as well as his employment training specialist, once per month. He takes Haldol for psychiatric symptoms and Cogentin and Vitamin E to alleviate side effects. He enjoys listening to music and running on the beach. He is currently taking two classes at the local junior college in theater arts appreciation and art history. He would like to continue his education and pursue a career in an artistic field or in sales. For almost two years, Steve has worked as a part-time clerk in a major department store in the Mid-Atlantic region. He stocks and organizes the merchandise and arranges displays in the shoe and luggage departments, which gross about $3500 daily. He lives in a supported apartment program, along with two other recipients of mental health services. Steve's first psychiatric hospitalization occurred prior to college and lasted for two years. He went on to gain a bachelor's degree in economics and political science and completed one year of law school. During the next four years, he lived in halfway houses, shelters, and was homeless. He had four more hospitalizations and attended day programs. His first work experience following this period was in the work adjustment program of a mental health agency. Steve's psychiatric diagnosis is schizophrenia. He takes Lithium, Stelazine, and Cogentin and meets with a psychiatrist once per month. He sees a psychologist weekly, and his job coach visits his work site twice per month. Steve also uses a recreation program at the mental health center extensively. He receives SSI and SSDI. He'd like to return to school and become a paralegal. Thomas works as a part-time utility clerk in a grocery store in the Midwest which employs about 120 people. His responsibilities include bagging groceries, doing price checks, retrieving carts from the parking lot, returning merchandise to shelves, and cleaning up spills. Along with several other workers with psychiatric disabilities, he is assisted by a job coach who is on-site at all times. The cost of the job coach's salary is shared by the grocery store and a mental health agency. Thomas lives in a supported apartment program which is owned by the mental health agency and is time-limited. His psychiatric diagnosis is organic personality disorder, and he takes Buspar. He sees a psychiatrist every three months and a case manager weekly. He has had one psychiatric hospitalization. After completing the eighth grade, Thomas held a series of short-term jobs in fast food restaurants, staying at some as briefly as one day. He also worked at three different grocery stores and a lumber store. When I met him, he had held his current job for nine months-the longest ever. He is an Elvis fan and enjoys watching wrestling matches. Joe is vice president for quality management at a hospital in the Northeast, where he develops and implements quality assessment and quality improvement programs for all aspects of health care delivery. Joe's psychiatric diagnosis is bipolar disorder, and he has had four psychiatric hospitalizations. The first three occurred during high school and college. After college, he advanced through administrative positions with increasing responsibility, all in the human services field. He earned an M.B.A. and spent six years as a senior executive in a state public health agency. He takes Lithium and Halcion and meets with a psychiatrist every four months. He also participates in a peer support group he helped to launch. He is married and has children. He plans to continue in this line of work and develop a consulting practice. Rosanna has worked as a full-time secretary in a government agency on the East Coast for the past two years. She has 10 years of experience as a marketing representative for a major electronics firm. She has also developed affirmative action plans for a defense contractor. She has a bachelor's degree in English literature and history and partial credits toward two master's degrees. Rosanna's psychiatric diagnosis is bipolar disorder. She is also in recovery from severe drug addiction and has been sober for four years. She has been hospitalized 11 times in the past 10 years; the longest stay was five months. She has been homeless on two occasions. Rosanna takes Thorazine and meets with a psychiatrist and psychotherapist as needed. She attends Adult Children of Alcoholics (ACOA) weekly. She exercises daily, including weight-lifting. Linda works as a recreation aide in a municipal senior day program in California. She's held this part-time job for 14 months. She has had a long-standing interest in working with elderly persons, including three years of experience as a personal care attendant. Prior to this job, she was in a sheltered workshop for one year. Linda completed high school and one semester of college. She receives SSI and lives in a board and-care home. Her psychiatric diagnosis is bipolar disorder. She takes Lithium, Tegretol, and Benadryl. She meets with a psychiatrist quarterly and participates in a self-help group weekly. A job coach and case worker are available to her as needed. She has had three psychiatric hospitalizations and has been homeless. Linda enjoys reading, listening to music, and learning about nutrition and health foods. |
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